Provider Demographics
NPI:1922380740
Name:MEDICAL CENTER OF LOUISIANA @ NEW ORLEANS
Entity Type:Organization
Organization Name:MEDICAL CENTER OF LOUISIANA @ NEW ORLEANS
Other - Org Name:URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLOCQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-903-5153
Mailing Address - Street 1:1541 TULANE AVE
Mailing Address - Street 2:ROOM 504
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2821
Mailing Address - Country:US
Mailing Address - Phone:504-903-5153
Mailing Address - Fax:
Practice Address - Street 1:2025 GRAVIER STREET
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-0000
Practice Address - Country:US
Practice Address - Phone:504-903-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA191261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========OtherTAX ID