Provider Demographics
NPI:1619286093
Name:PEOPLES HEALTH CLINICAL LLC
Entity Type:Organization
Organization Name:PEOPLES HEALTH CLINICAL LLC
Other - Org Name:PRIMARY CARE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-681-8532
Mailing Address - Street 1:3838 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-8194
Mailing Address - Country:US
Mailing Address - Phone:504-681-8155
Mailing Address - Fax:504-681-8260
Practice Address - Street 1:120 MEADOWCREST STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5247
Practice Address - Country:US
Practice Address - Phone:504-620-5661
Practice Address - Fax:504-620-5675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.10349R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty