Provider Demographics
NPI:1063692705
Name:PLAZA MEDICAL CENTER, LTD
Entity type:Organization
Organization Name:PLAZA MEDICAL CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:G
Authorized Official - Last Name:FIDELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-324-6416
Mailing Address - Street 1:4301 ELYSIAN FIELDS AVE
Mailing Address - Street 2:103
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3875
Mailing Address - Country:US
Mailing Address - Phone:504-324-6416
Mailing Address - Fax:504-324-6417
Practice Address - Street 1:4301 ELYSIAN FIELDS AVE
Practice Address - Street 2:103
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3875
Practice Address - Country:US
Practice Address - Phone:504-324-6416
Practice Address - Fax:504-324-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA904OtherLICENSE