Provider Demographics
NPI:1376669952
Name:CULICCHIA NEUROLOGICAL CLINIC, LLC
Entity Type:Organization
Organization Name:CULICCHIA NEUROLOGICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-340-6976
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD.
Mailing Address - Street 2:STE. S-750
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-340-6976
Mailing Address - Fax:504-349-6775
Practice Address - Street 1:1111 MEDICAL CENTER BLVD.
Practice Address - Street 2:STE. S-750
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-340-6976
Practice Address - Fax:504-349-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1797626Medicaid
LA5B422Medicare PIN
LA1797626Medicaid