Basic Information
| Provider Information | |||||||||
| NPI: | 1639488984 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISE GAUTREAUX COLLINS, M.D. L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3555 LOYOLA DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700657706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044647729 | ||||||||
| FaxNumber: | 5044646343 | ||||||||
| Practice Location | |||||||||
| Address1: | 3555 LOYOLA DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700657706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044647729 | ||||||||
| FaxNumber: | 5044646343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHERAMIE | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | GAUTREAUX | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5044647729 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 10500R | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1490687 | 05 | LA | MEDICAID |