Healthcare Provider Details

I. General information

NPI: 1104239482
Provider Name (Legal Business Name): ACCESS HEALTH LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 SOUTH ST
PARADIS LA
70080-2244
US

IV. Provider business mailing address

2900 INDIANA AVE
KENNER LA
70065-4605
US

V. Phone/Fax

Practice location:
  • Phone: 985-306-0414
  • Fax: 504-575-3691
Mailing address:
  • Phone: 504-575-3712
  • Fax: 504-575-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6505
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP05965
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARK KEISER
Title or Position: PRESIDENT
Credential:
Phone: 504-575-3700