Provider Demographics
NPI:1942758289
Name:GRETNA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:GRETNA MEDICAL CENTER LLC
Other - Org Name:GRETNA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAI
Authorized Official - Middle Name:NAM
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-364-1844
Mailing Address - Street 1:315 WESTBANK EXPY
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5616
Mailing Address - Country:US
Mailing Address - Phone:504-364-1844
Mailing Address - Fax:504-367-6022
Practice Address - Street 1:315 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5616
Practice Address - Country:US
Practice Address - Phone:504-364-1844
Practice Address - Fax:504-367-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.023174207R00000X, 207R00000X
LA1639673T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty