Provider Demographics
NPI:1033474655
Name:MHSD
Entity Type:Organization
Organization Name:MHSD
Other - Org Name:CABHS-WESTBANK CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:504-361-6092
Mailing Address - Street 1:4222 GEN. MEYER AVE.
Mailing Address - Street 2:STE. 100
Mailing Address - City:N.O.
Mailing Address - State:LA
Mailing Address - Zip Code:70131
Mailing Address - Country:US
Mailing Address - Phone:504-361-6092
Mailing Address - Fax:504-361-6256
Practice Address - Street 1:3710 RUE DELPHINE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-7241
Practice Address - Country:US
Practice Address - Phone:504-361-6092
Practice Address - Fax:504-361-6256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHH/OBS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA30302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA30OtherMANAGED CARE ORGANIZATION