Organization
CENTRAL CITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZAN JACKSON (ADMINISTRATOR)
(504) 241-7751
Entity
Organization
Contact information
Practice address
2426 SIMON BOLIVAR AVE, NEW ORLEANS, LA 70113-2548
(504) 517-1607
(504) 571-1609
Mailing address
2426 SIMON BOLIVAR AVE, NEW ORLEANS, LA 70113-2548
(504) 517-1607
(504) 571-1609
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1155381
—
LA
Enumeration date
09/25/2015
Last updated
09/25/2015
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