Organization
TECHE ACTION BOARD, INC.
Active
Other names
Teche Action Clinic @ Galliano
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY WILTZ MD (CEO)
(337) 828-2550
Entity
Organization
Contact information
Practice address
121 WEST 134TH PLACE, GALLIANO, LA 70354
(337) 828-2550
(337) 355-2335
Mailing address
1115 WEBER ST, FRANKLIN, LA 70538-4124
(337) 828-2550
(337) 355-2335
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2381849
—
LA
01
—
5B803
MEDICARE PART B
LA
Enumeration date
03/19/2014
Last updated
07/20/2016
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