MEDICARE: LOWER 9TH WARD HEALTH 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
1	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1467687707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWER 9TH WARD HEALTH CLINIC

Provider Business Mailing Address
First Line	:	5228 SAINT CLAUDE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-3752
Country	:	US
Telephone Number	:	504-309-0918
Fax Number	:	504-371-5609

Provider Business Practice Location Address
First Line	:	5228 SAINT CLAUDE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-3752
Country	:	US
Telephone Number	:	504-309-0918
Fax Number	:	504-371-5609

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. ALICE HAZEL CRAFT-KERNEY
Credential	:	RN
Telephone Number	:	504-309-0918

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	05/15/2009

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