Basic Information
| Provider Information | |||||||||
| NPI: | 1932440500 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST COMMUNITY HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4960 SAINT CLAUDE AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701174258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045334999 | ||||||||
| FaxNumber: | 5045030299 | ||||||||
| Practice Location | |||||||||
| Address1: | 4960 ST. CLAUDE AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701173840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045334999 | ||||||||
| FaxNumber: | 5042839344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2013 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | BENANDI | ||||||||
| AuthorizedOfficialFirstName: | TINA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING | ||||||||
| AuthorizedOfficialTelephone: | 5047045949 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | LALCS31529 | LA | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 2107381 | 05 | LA | MEDICAID |