Provider Demographics
NPI:1992975007
Name:FAMILY HEALTH CARE OF ST. BERNARD
Entity type:Organization
Organization Name:FAMILY HEALTH CARE OF ST. BERNARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:CRAFT
Authorized Official - Last Name:LABARRE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:504-278-1884
Mailing Address - Street 1:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70044-1429
Mailing Address - Country:US
Mailing Address - Phone:504-278-1884
Mailing Address - Fax:504-278-1886
Practice Address - Street 1:8050 W JUDGE PEREZ DR
Practice Address - Street 2:SUITE 2200
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1734
Practice Address - Country:US
Practice Address - Phone:504-278-1884
Practice Address - Fax:504-278-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19D1083407OtherCLIA
LA1150525Medicaid
LABITAR-212256329DOtherBCBS OF LA - BITAR-212256329D PAULA- 4371133840 TAMMI-4333196390
LA1150525Medicaid