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General NPI Number Information
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NPI Number | 1750492898
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Entity Type | Organization
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Legal Business Name | BELLE CHASSE FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 8200 HWY 23
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City | BELLE CHASSE
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State | LA
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Zip | 70037
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Country | US
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Telephone | 504-398-1100
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Fax | 504-398-1030
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Provider Business Mailing Address
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Address Line | 8200 HWY 23
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City | BELLE CHASSE
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State | LA
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Zip | 70037
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Country | US
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Telephone | 504-398-1100
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Fax | 504-398-1030
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | KATHRYN LETULLE
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Credential |
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Telephone | 504-398-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L015363
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License Number State | LA
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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 | 13819R
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License Number State | LA
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