Provider Demographics
NPI:1508163411
Name:MEDICAL CENTER OF GENTILLY
Entity Type:Organization
Organization Name:MEDICAL CENTER OF GENTILLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:TIMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-244-1991
Mailing Address - Street 1:5824 HAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-1344
Mailing Address - Country:US
Mailing Address - Phone:504-244-1991
Mailing Address - Fax:
Practice Address - Street 1:7901 DOWNMAN RD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-1200
Practice Address - Country:US
Practice Address - Phone:504-244-1991
Practice Address - Fax:504-244-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-13
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017776261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1357561Medicaid
LA1357561Medicaid