Provider Demographics
NPI:1164683645
Name:MCKENNA GENERAL MEDICAL, LLC
Entity Type:Organization
Organization Name:MCKENNA GENERAL MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-943-1923
Mailing Address - Street 1:1827 GENTILLY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2051
Mailing Address - Country:US
Mailing Address - Phone:504-943-1923
Mailing Address - Fax:504-943-1933
Practice Address - Street 1:1827 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2051
Practice Address - Country:US
Practice Address - Phone:504-943-1923
Practice Address - Fax:504-943-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1129267Medicaid
LAUP4206OtherUNITED HEALTHCARE
LAF4229OtherBLUE CROSS/BLUE SHIELD
LA436664206BOtherBLUE CROSS/BLUE SHIELD
LAF4229OtherBLUE CROSS/BLUE SHIELD
LADO4226Medicare UPIN