Provider Demographics
NPI:1073779054
Name:SAHASRA MEDICAL CLINIC
Entity Type:Organization
Organization Name:SAHASRA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IESHA
Authorized Official - Middle Name:ISHEA
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:504-762-0245
Mailing Address - Street 1:1403 BODENGER BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6001
Mailing Address - Country:US
Mailing Address - Phone:832-699-9734
Mailing Address - Fax:281-710-6222
Practice Address - Street 1:4141 SOUTHWEST FWY STE 510
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7334
Practice Address - Country:US
Practice Address - Phone:832-699-9734
Practice Address - Fax:281-710-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty