Provider Demographics
NPI:1295872992
Name:ALEXANDRIA WOMENS CENTER A MEDICAL
Entity type:Organization
Organization Name:ALEXANDRIA WOMENS CENTER A MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:AUCOIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-443-7222
Mailing Address - Street 1:P.O. BOX 13318
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-9998
Mailing Address - Country:US
Mailing Address - Phone:318-443-7222
Mailing Address - Fax:318-443-7641
Practice Address - Street 1:3304 MASONIC DRIVE
Practice Address - Street 2:SUITE 4001
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-9998
Practice Address - Country:US
Practice Address - Phone:318-443-7222
Practice Address - Fax:318-443-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1917664Medicaid
LA1489301Medicaid
LA1492183Medicaid
LA1363961Medicaid
LAB61793Medicare UPIN
LA1489301Medicaid
LA51371CE06Medicare ID - Type UnspecifiedJAMES L. GATES MD
LA5N213CE06Medicare ID - Type UnspecifiedGLENN R. AUCOIN MD
LA1363961Medicaid
LA5E299CE06Medicare ID - Type UnspecifiedEDAN D. MORAN MR
LAG86166Medicare UPIN
LA1492183Medicaid