Basic Information
Provider Information
NPI: 1952941767
EntityType: 2
ReplacementNPI:  
OrganizationName: BAPTIST COMMUNITY HEALTH SERVICES, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4960 SAINT CLAUDE AVE
Address2:  
City: NEW ORLEANS
State: LA
PostalCode: 701174258
CountryCode: US
TelephoneNumber: 5047045949
FaxNumber: 5047045989
Practice Location
Address1: 1445 W CAUSEWAY APPROACH
Address2:  
City: MANDEVILLE
State: LA
PostalCode: 704713045
CountryCode: US
TelephoneNumber: 5045334999
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/09/2020
LastUpdateDate: 10/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BENANDI
AuthorizedOfficialFirstName: TINA
AuthorizedOfficialMiddleName: MARIE
AuthorizedOfficialTitleorPosition: DIRECTOR OF REVENUE CYCLE MGNT
AuthorizedOfficialTelephone: 5047045949
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 
261QF0400X  Y Ambulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)

No ID Information.


Home