Provider Demographics
NPI:1083607782
Name:FAMILY MEDICINE OF NEW ORLEANS LLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF NEW ORLEANS LLC
Other - Org Name:THE FAMILYMD MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:ECKERT
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-359-3763
Mailing Address - Street 1:4208 MACON DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1939
Mailing Address - Country:US
Mailing Address - Phone:985-359-3763
Mailing Address - Fax:983-359-2472
Practice Address - Street 1:501 RUE DE SANTE
Practice Address - Street 2:SUITE 7
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5400
Practice Address - Country:US
Practice Address - Phone:985-359-3763
Practice Address - Fax:985-359-2472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CM69Medicare PIN