Provider Demographics
NPI:1295149219
Name:THE CITY OF NEW ORLEANS
Entity type:Organization
Organization Name:THE CITY OF NEW ORLEANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:TEVINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-658-2576
Mailing Address - Street 1:2222 SIMON BOLIVAR AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-1460
Mailing Address - Country:US
Mailing Address - Phone:504-658-2785
Mailing Address - Fax:504-658-2876
Practice Address - Street 1:1530 GRAVIER STREET
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-658-2785
Practice Address - Fax:504-658-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7260000969Medicaid