Provider Demographics
NPI:1558775494
Name:METRO MEDICAL CLINIC OF NEW ORLEANS, LLA
Entity Type:Organization
Organization Name:METRO MEDICAL CLINIC OF NEW ORLEANS, LLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-573-4726
Mailing Address - Street 1:1313 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6841
Mailing Address - Country:US
Mailing Address - Phone:318-573-4726
Mailing Address - Fax:
Practice Address - Street 1:1313 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6841
Practice Address - Country:US
Practice Address - Phone:318-573-4726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty