Provider Demographics
NPI:1245572411
Name:CRESCENT CITY HEADACHE AND NEUROLOGY CENTER LLC
Entity type:Organization
Organization Name:CRESCENT CITY HEADACHE AND NEUROLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:REDILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-957-1766
Mailing Address - Street 1:2116 PAKENHAM DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4722
Mailing Address - Country:US
Mailing Address - Phone:504-301-1468
Mailing Address - Fax:
Practice Address - Street 1:2116 PAKENHAM DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4722
Practice Address - Country:US
Practice Address - Phone:504-301-1468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15249R2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H51259Medicare UPIN