MEDICARE: ALEXANDRIA WOMENS CENTER A MEDICAL

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	207VX0000X	Obstetrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295872992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDRIA WOMENS CENTER A MEDICAL

Provider Business Mailing Address
First Line	:	P.O. BOX 13318
Second Line	:	SUITE 410
City	:	ALEXANDRIA
State	:	LA
Zip	:	71315-9998
Country	:	US
Telephone Number	:	318-443-7222
Fax Number	:	318-443-7641

Provider Business Practice Location Address
First Line	:	3304 MASONIC DRIVE
Second Line	:	SUITE 4001
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-9998
Country	:	US
Telephone Number	:	318-443-7222
Fax Number	:	318-443-7641

Authorized Official
Title or Position	:	VICE PRESIDENT/TREASURER
Name	:	DR. GLENN RICHARD AUCOIN
Credential	:	M.D.
Telephone Number	:	318-443-7222

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	10/10/2019

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