MEDICARE: CHAMPION MEDICAL CENTER

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1932334398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPION MEDICAL CENTER

Provider Business Mailing Address
First Line	:	9890 LAKE FOREST BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2607
Country	:	US
Telephone Number	:	504-241-3560
Fax Number	:

Provider Business Practice Location Address
First Line	:	9890 LAKE FOREST BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2607
Country	:	US
Telephone Number	:	504-241-3560
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GREGORY LYNN DAVIS
Credential	:
Telephone Number	:	504-241-3560

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	05/28/2009

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Directions to “CHAMPION MEDICAL CENTER ” Practice Location

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