Provider Demographics
NPI:1750492898
Name:BELLE CHASSE FAMILY MEDICAL CLINIC
Entity Type:Organization
Organization Name:BELLE CHASSE FAMILY MEDICAL CLINIC
Other - Org Name:LAWRENCE A GIAMHELLUCA HECTOR M CABRERA
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LETULLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-398-1100
Mailing Address - Street 1:8200 HWY 23
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037
Mailing Address - Country:US
Mailing Address - Phone:504-398-1100
Mailing Address - Fax:504-398-1030
Practice Address - Street 1:8200 HWY 23
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037
Practice Address - Country:US
Practice Address - Phone:504-398-1100
Practice Address - Fax:504-398-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL015363207Q00000X
LA13819R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1439151Medicaid
LA1572292Medicaid
LA1319627Medicaid
LA1441392Medicaid
G62627Medicare UPIN
LA5C846Medicare PIN
LA1441392Medicaid
LA4P684Medicare PIN
LA51016Medicare PIN