MEDICARE: HIV-AIDS ALLIANCE FOR REGION TWO

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1770119588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIV-AIDS ALLIANCE FOR REGION TWO

Provider Business Mailing Address
First Line	:	9516 AIRLINE HWY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-5501
Country	:	US
Telephone Number	:	225-655-6422
Fax Number	:	225-341-5903

Provider Business Practice Location Address
First Line	:	3849 NORTH BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3854
Country	:	US
Telephone Number	:	225-655-6422
Fax Number	:	225-927-7367

Authorized Official
Title or Position	:	CEO
Name	:	ASHLEY STEWART
Credential	:
Telephone Number	:	225-424-1743

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	06/08/2023

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