Healthcare Provider Details

I. General information

NPI: 1639763519
Provider Name (Legal Business Name): START CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S GALVEZ ST
NEW ORLEANS LA
70125-3102
US

IV. Provider business mailing address

PO BOX 165
HOUMA LA
70361-0165
US

V. Phone/Fax

Practice location:
  • Phone: 504-332-5713
  • Fax: 504-587-1537
Mailing address:
  • Phone: 985-333-2020
  • Fax: 985-851-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE BROUSSARD
Title or Position: VICE PRESIDENT OF COMPLIANCE
Credential:
Phone: 985-333-2020