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General NPI Number Information
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NPI Number | 1063785996
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Entity Type | Organization
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Legal Business Name | ADVANTAGE SUBOXONE CLINIC, INC
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 3349 RIDGELAKE DR
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City | METAIRIE
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State | LA
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Zip | 70002-3851
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Country | US
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Telephone | 504-495-9519
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Fax |
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Provider Business Mailing Address
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Address Line | 6872 JEFFERSON HWY
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City | NEW ORLEANS
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State | LA
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Zip | 70123-4925
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Country | US
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Telephone | 504-495-9519
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEIA ANN FRICKEY
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Credential | MD
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Telephone | 504-495-9519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 020845
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License Number State | LA
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