Provider Demographics
NPI:1780199265
Name:BAPTIST COMMUNITY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:BAPTIST COMMUNITY HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECICALIST
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BENANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-704-5949
Mailing Address - Street 1:4960 SAINT CLAUDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-4258
Mailing Address - Country:US
Mailing Address - Phone:504-704-5949
Mailing Address - Fax:504-704-5989
Practice Address - Street 1:4960 SAINT CLAUDE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-4258
Practice Address - Country:US
Practice Address - Phone:504-704-5949
Practice Address - Fax:504-704-5989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALALCS31529261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========Medicaid