MEDICARE: MARILLAC COMMUNITY HEALTH CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1043663214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARILLAC COMMUNITY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	PO BOX 13038
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70185-3038
Country	:	US
Telephone Number	:	504-207-3060
Fax Number	:	504-483-6016

Provider Business Practice Location Address
First Line	:	3215 GENERAL MEYER AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-3204
Country	:	US
Telephone Number	:	504-362-8930
Fax Number	:	504-362-8486

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MICHAEL GRIFFIN
Credential	:
Telephone Number	:	504-207-3060

Provider Enumeration Date	:	07/22/2016
Last Update Date	:	11/22/2022

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