Healthcare Provider Details

I. General information

NPI: 1467888966
Provider Name (Legal Business Name): OCHSNER CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 15TH ST
GULFPORT MS
39501-2523
US

IV. Provider business mailing address

PO BOX 58451
NEW ORLEANS LA
70154-4851
US

V. Phone/Fax

Practice location:
  • Phone: 855-312-4191
  • Fax:
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE K CARDWELL
Title or Position: AVP
Credential:
Phone: 504-842-7208