Provider Demographics
NPI:1922437441
Name:SUPERIOR MEDICINE GROUP LLC
Entity Type:Organization
Organization Name:SUPERIOR MEDICINE GROUP LLC
Other - Org Name:WESTBANK MEDICAL & WALK-IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:TILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-495-3572
Mailing Address - Street 1:6621 WESTBANK EXPY
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6621 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2669
Practice Address - Country:US
Practice Address - Phone:504-495-3572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2111906Medicaid
LA2111906Medicaid