Basic Information
| Provider Information | |||||||||
| NPI: | 1962879908 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MID-CITY PRIMARY CARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3844 CONVENTION ST | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708063803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252896803 | ||||||||
| FaxNumber: | 2252896483 | ||||||||
| Practice Location | |||||||||
| Address1: | 3844 CONVENTION ST | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708063803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252896803 | ||||||||
| FaxNumber: | 2252896483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2015 | ||||||||
| LastUpdateDate: | 08/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | CHIMEKA-ANYANWOKE | ||||||||
| AuthorizedOfficialFirstName: | GERTRUDE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDIAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2252896803 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.