Healthcare Provider Details

I. General information

NPI: 1952604274
Provider Name (Legal Business Name): MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 POYDRAS ST.
NEW ORLEANS LA
70119-7561
US

IV. Provider business mailing address

2021 PERDIDO ST
NEW ORLEANS LA
70112-1352
US

V. Phone/Fax

Practice location:
  • Phone: 504-903-6572
  • Fax: 504-903-5313
Mailing address:
  • Phone: 504-903-5153
  • Fax: 504-680-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number191-C
License Number StateLA

VIII. Authorized Official

Name: ROXANE A TOWNSEND
Title or Position: INTERIM CEO
Credential: M.D.
Phone: 504-903-4907