Organization
INDEPENDENCE MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDMOND WOOD MD (OWNER)
(504) 338-4268
Entity
Organization
Contact information
Practice address
281 W 4TH ST, INDEPENDENCE, LA 70443-2386
(504) 338-4268
Mailing address
7300 LAKESHORE DR APT 10, NEW ORLEANS, LA 70124-2462
(504) 338-4268
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1910864
—
LA
Enumeration date
02/27/2014
Last updated
07/10/2014
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