Provider Demographics
NPI:1477644359
Name:ST TAMMANY COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:ST TAMMANY COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHURI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-785-5852
Mailing Address - Street 1:843 MILLING AVE
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-4442
Mailing Address - Country:US
Mailing Address - Phone:985-785-5852
Mailing Address - Fax:985-785-5811
Practice Address - Street 1:1340 14TH ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2944
Practice Address - Country:US
Practice Address - Phone:985-649-8775
Practice Address - Fax:985-649-8703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST CHARLES COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-27
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD10981R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1452904Medicaid
LA1925349Medicaid
LA1579483Medicaid
LA1444642Medicaid
LA1945421Medicaid
LA1945421Medicaid