Provider Demographics
NPI:1265467799
Name:ELISHAS MEDICAL HEALTHCARE SERVICE
Entity Type:Organization
Organization Name:ELISHAS MEDICAL HEALTHCARE SERVICE
Other - Org Name:MECCA MEDICAL HEALTHCARE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-821-9111
Mailing Address - Street 1:3025 WHITTY DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-1380
Mailing Address - Country:US
Mailing Address - Phone:504-821-9111
Mailing Address - Fax:504-821-9198
Practice Address - Street 1:3308 TULANE AVE STE 411
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7100
Practice Address - Country:US
Practice Address - Phone:504-821-9111
Practice Address - Fax:504-821-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CA13Medicare ID - Type Unspecified