MEDICARE: DEPARTMENT OF HEALTH AND HOSPITALS, OFFICE OF PUBLIC HEALTH

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	:	1558624486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPARTMENT OF HEALTH AND HOSPITALS, OFFICE OF PUBLIC HEALTH

Provider Business Mailing Address
First Line	:	14931 WOODLORE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-1553
Country	:	US
Telephone Number	:	225-954-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7173A FLORIDA BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4549
Country	:	US
Telephone Number	:	225-922-3218
Fax Number	:	225-925-7245

Authorized Official
Title or Position	:	NURSE
Name	:	MS. PRISCILLA WILLIAMS
Credential	:
Telephone Number	:	225-275-5620

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	06/15/2012

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