Provider Demographics
NPI:1396780193
Name:WOMAN'S MATERNAL FETAL MEDICINE
Entity type:Organization
Organization Name:WOMAN'S MATERNAL FETAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:G
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-927-1300
Mailing Address - Street 1:9000 AIRLINE HIGHWAY
Mailing Address - Street 2:SUITE 370
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4114
Mailing Address - Country:US
Mailing Address - Phone:225-924-8338
Mailing Address - Fax:225-922-3745
Practice Address - Street 1:9000 AIRLINE HIGHWAY
Practice Address - Street 2:SUITE 370
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4114
Practice Address - Country:US
Practice Address - Phone:225-924-8338
Practice Address - Fax:225-922-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444154Medicaid
LA1444154Medicaid