MEDICARE: ELISHAS MEDICAL HEALTHCARE SERVICE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QP2000X	Physical Therapy Clinic/Center
2	261QM2500X	Medical Specialty Clinic/Center
3	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1265467799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELISHAS MEDICAL HEALTHCARE SERVICE

Provider Business Mailing Address
First Line	:	3025 WHITTY DR
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-1380
Country	:	US
Telephone Number	:	504-821-9111
Fax Number	:	504-821-9198

Provider Business Practice Location Address
First Line	:	3308 TULANE AVE STE 411
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-7100
Country	:	US
Telephone Number	:	504-821-9111
Fax Number	:	504-821-9198

Authorized Official
Title or Position	:	OWNER
Name	:	ELISHA HATCH
Credential	:
Telephone Number	:	504-821-9111

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	06/18/2008

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Directions to “ELISHAS MEDICAL HEALTHCARE SERVICE ” Practice Location

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