Provider Demographics
NPI:1194998500
Name:VERSAILLES NEIGHBORHOOD CLINIC
Entity type:Organization
Organization Name:VERSAILLES NEIGHBORHOOD CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-726-9333
Mailing Address - Street 1:4657 ALCEE FORTIER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-2140
Mailing Address - Country:US
Mailing Address - Phone:504-254-4011
Mailing Address - Fax:
Practice Address - Street 1:4657 ALCEE FORTIER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2140
Practice Address - Country:US
Practice Address - Phone:504-254-4011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DD32Medicare PIN