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NPI Code Detail

MEDICARE: SAHASRA MEDICAL CLINIC

MEDICARE: SAHASRA MEDICAL CLINIC
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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1073779054
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAHASRA MEDICAL CLINIC
Provider Business Mailing Address
First Line : 1403 BODENGER BLVD
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70114-6001
Country : US
Telephone Number : 832-699-9734
Fax Number : 281-710-6222
Provider Business Practice Location Address
First Line : 4141 SOUTHWEST FWY STE 510
Second Line :
City : HOUSTON
State : TX
Zip : 77027-7334
Country : US
Telephone Number : 832-699-9734
Fax Number : 281-710-6222
Authorized Official
Title or Position : OWNER
Name : IESHA ISHEA GRANT
Credential : APRN-BC
Telephone Number : 504-762-0245
Provider Enumeration Date : 07/30/2008
Last Update Date : 06/17/2020

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Directions to “SAHASRA MEDICAL CLINIC ” Practice Location

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