Healthcare Provider Details

I. General information

NPI: 1730933201
Provider Name (Legal Business Name): ASCENSION DEPAUL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 04/12/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 GENERAL DE GAULLE DRIVE
NEW ORLEANS LA
70114
US

IV. Provider business mailing address

PO BOX 13038
NEW ORLEANS LA
70185-3038
US

V. Phone/Fax

Practice location:
  • Phone: 504-362-8930
  • Fax: 504-368-8486
Mailing address:
  • Phone: 504-207-3059
  • Fax: 504-483-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GRIFFIN
Title or Position: PRESIDENT -CEO
Credential:
Phone: 504-307-1188