Organization
BIENVILLE DIALYSIS CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHARLOTTE GUIDROZ (ADMINISTRATIVE ASSISTANT)
(504) 780-1422
Entity
Organization
Contact information
Practice address
3333 BIENVILLE ST, NEW ORLEANS, LA 70119-5301
(504) 822-6336
Mailing address
4424 CONLIN ST, SUITE 2A, METAIRIE, LA 70006-2147
(504) 780-1422
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
100
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1343005
—
LA
01
—
34514
BLUE CROSS BLUE SHIELD LA
LA
Enumeration date
06/18/2006
Last updated
12/03/2014
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