Provider Demographics
NPI:1205019908
Name:WOMAN'S ASSESSMENT CENTER PHYSICIANS
Entity Type:Organization
Organization Name:WOMAN'S ASSESSMENT CENTER PHYSICIANS
Other - Org Name:WOMAN'S HOSPITAL FOUNDATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:G
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-927-1300
Mailing Address - Street 1:9050 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4103
Mailing Address - Country:US
Mailing Address - Phone:225-924-8338
Mailing Address - Fax:
Practice Address - Street 1:9050 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4103
Practice Address - Country:US
Practice Address - Phone:225-924-8338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOMAN HOSPITAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAPPLIED FORMedicaid