Healthcare Provider Details

I. General information

NPI: 1477644359
Provider Name (Legal Business Name): ST TAMMANY COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 14TH ST
SLIDELL LA
70458-2944
US

IV. Provider business mailing address

843 MILLING AVE
LULING LA
70070-4442
US

V. Phone/Fax

Practice location:
  • Phone: 985-649-8775
  • Fax: 985-649-8703
Mailing address:
  • Phone: 985-785-5852
  • Fax: 985-785-5811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD10981R
License Number StateLA

VIII. Authorized Official

Name: DR. MADHURI DIXIT
Title or Position: MD
Credential: MD
Phone: 985-785-5852