Provider Demographics
NPI:1578940060
Name:J.M. FORTINO, MD AMEDICAL CORPORATION
Entity Type:Organization
Organization Name:J.M. FORTINO, MD AMEDICAL CORPORATION
Other - Org Name:CHILDREN'S CLINIC A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-367-8777
Mailing Address - Street 1:1301 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5025
Mailing Address - Country:US
Mailing Address - Phone:504-367-8777
Mailing Address - Fax:504-367-0133
Practice Address - Street 1:1301 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5025
Practice Address - Country:US
Practice Address - Phone:504-367-8777
Practice Address - Fax:504-367-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center