Provider Demographics
NPI:1265971071
Name:ADVANCED MEDICAL CENTER OF GENTILLY,LLC
Entity type:Organization
Organization Name:ADVANCED MEDICAL CENTER OF GENTILLY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-394-0001
Mailing Address - Street 1:4035 TOURO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3140
Mailing Address - Country:US
Mailing Address - Phone:504-286-7808
Mailing Address - Fax:504-286-1136
Practice Address - Street 1:4035 TOURO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3140
Practice Address - Country:US
Practice Address - Phone:504-286-7808
Practice Address - Fax:504-286-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty