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General NPI Number Information
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NPI Number | 1093874000
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Entity Type | Organization
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Legal Business Name | ST GABRIEL HEALTH CLINIC INC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 5760 MONTICELLO DR
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City | SAINT GABRIEL
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State | LA
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Zip | 70776-4412
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Country | US
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Telephone | 225-642-9676
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Fax | 225-642-9696
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Provider Business Mailing Address
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Address Line | PO BOX 209
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City | SAINT GABRIEL
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State | LA
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Zip | 70776-0209
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Country | US
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Telephone | 225-642-9676
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Fax | 225-642-9696
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Authorized Official
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Title or Position | CEO
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Name | MR. ASHLEY T. LEVY
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Credential |
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Telephone | 225-642-9676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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