Provider Demographics
NPI:1740865864
Name:JOSHUA M. GROETSCH, MD LLC
Entity type:Organization
Organization Name:JOSHUA M. GROETSCH, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GROETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-460-1848
Mailing Address - Street 1:2800 VETERANS BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-833-5755
Mailing Address - Fax:504-832-9629
Practice Address - Street 1:2800 VETERANS BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-833-5755
Practice Address - Fax:504-832-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1045284Medicaid
LA2444506Medicaid