Provider Demographics
NPI:1740045509
Name:CHALMETTE WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:CHALMETTE WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GOVAN
Authorized Official - Last Name:WORK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-272-0115
Mailing Address - Street 1:1013B W JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4703
Mailing Address - Country:US
Mailing Address - Phone:504-272-0115
Mailing Address - Fax:504-366-5260
Practice Address - Street 1:1013B W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4703
Practice Address - Country:US
Practice Address - Phone:504-272-0115
Practice Address - Fax:504-366-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service