Provider Demographics
NPI:1396115978
Name:CENTRAL CITY
Entity type:Organization
Organization Name:CENTRAL CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-241-7751
Mailing Address - Street 1:2426 SIMON BOLIVAR AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-2548
Mailing Address - Country:US
Mailing Address - Phone:504-517-1607
Mailing Address - Fax:504-571-1609
Practice Address - Street 1:2426 SIMON BOLIVAR AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-2548
Practice Address - Country:US
Practice Address - Phone:504-517-1607
Practice Address - Fax:504-571-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1155381Medicaid