Provider Demographics
NPI:1871265694
Name:AMBULATORY MEDICAL GROUP
Entity Type:Organization
Organization Name:AMBULATORY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCLENDON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:504-615-5981
Mailing Address - Street 1:1500 LAFAYETTE ST STE 141
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5758
Mailing Address - Country:US
Mailing Address - Phone:504-510-5511
Mailing Address - Fax:504-518-6378
Practice Address - Street 1:5646 READ BLVD STE 380
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3148
Practice Address - Country:US
Practice Address - Phone:504-518-5822
Practice Address - Fax:504-518-6378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty