Provider Demographics
NPI:1427175421
Name:MID-TOWN MEDICAL
Entity type:Organization
Organization Name:MID-TOWN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-895-0990
Mailing Address - Street 1:3500 SAINT CHARLES AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-7101
Mailing Address - Country:US
Mailing Address - Phone:504-895-0990
Mailing Address - Fax:504-895-7490
Practice Address - Street 1:3500 SAINT CHARLES AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-7101
Practice Address - Country:US
Practice Address - Phone:504-895-0990
Practice Address - Fax:504-895-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025031261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1529508Medicaid