Provider Demographics
NPI:1902214133
Name:ACCESS HEALTH LOUISIANA
Entity Type:Organization
Organization Name:ACCESS HEALTH LOUISIANA
Other - Org Name:ST CHARLES CHC - 1057 PAUL MAILLARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-575-3700
Mailing Address - Street 1:2900 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4605
Mailing Address - Country:US
Mailing Address - Phone:504-575-3712
Mailing Address - Fax:504-575-3691
Practice Address - Street 1:1057 PAUL MAILLARD RD
Practice Address - Street 2:SUITE 240
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4349
Practice Address - Country:US
Practice Address - Phone:985-785-2045
Practice Address - Fax:504-575-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.04201R207RC0000X
LAMD.03945R207RN0300X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2384457Medicaid