TECHE ACTION BOARD INC (NPI# 1386880433) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386880433 |
| Entity Type | Organization |
| Organization Name | TECHE ACTION BOARD INC |
| Other Organization Name | TECHE ACTION CLINIC @ RESERVE |
| Practice Address |
473 Central Ave Reserve LA 70084-5509 |
| Mailing Address |
1115 Weber Street Franklin LA 70538-4124 |
| Practice Telephone | 9854791315 |
| Practice Fax Number | 9854791328 |
| Mailing Telephone | 3378282550 |
| Mailing Fax Number | 3373552335 |
| Enumeration Date | 2008-12-19 |
| Last Update Date | 2016-07-20 |
| Authorized Official Name | DR. GARY M WILTZ (CEO) |
| Authorized Official Telephone | 3378282550 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | TECHE ACTION BOARD, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
LA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1803782 | 05 | |
| LA | MEDICARE PART B | 5B803 | 01 |
| Other Name | Type Code |
|---|---|
| Teche Action Clinic @ Reserve | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972746964 | Teche Action Board Inc | Clinic/Center | 3528 Highway 70 S, Pierre Part, LA 70339-4452 | 2009-04-07 |
| 1124307566 | Teche Action Board Inc | Clinic/Center | 1124 7th St, Morgan City, LA 70380-1951 | 2011-08-16 |
| 1679726459 | Teche Action Board Inc | Pharmacy | 1014 W Tunnel Blvd, Houma, LA 70360-4050 | 2008-10-24 |
| 1174579262 | Teche Action Board Inc | Clinic/Center | 1115 Weber St, Franklin, LA 70538-4124 | 2006-05-26 |
| Street Address |
473 CENTRAL AVE |
| City | RESERVE |
| State | LA |
| Zip Code | 70084-5509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053666909 | Roxanne Campbell | Dietitian, Registered | 473 Central Ave, Reserve, LA 70084-5509 | 2012-07-17 |
| 1770846511 | Cathy Roussell Dennis | Registered Nurse | 473 Central Ave, Reserve, LA 70084-5509 | 2012-06-18 |
| 1205198132 | Monique Sorapuru Cook | Registered Nurse | 473 Central Ave, Reserve, LA 70084-5509 | 2012-06-15 |
| 1992830970 | Sedera Montgomery | Registered Nurse | 473 Central Ave, Reserve, LA 70084-5509 | 2007-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891289831 | Patrice Edwards Robinson | Nurse Practitioner | 1 Wildcat Drive, Reserve, LA 70084 | 2018-06-21 |
| 1083148506 | Laotis Dee Dennis | Counselor | 579 Nw 2nd St, Reserve, LA 70084 | 2017-04-12 |
| 1659613032 | Varsha Jasti | Internal Medicine | St John Va Outpatient Clinic 4004 West Airline Hwy, Reserve, LA 70084 | 2013-03-22 |
| 1235264367 | Brett D Madere Dds Apc | Dentist | 190 Central Avenue Reserve La, Reserve, LA 70084 | 2007-02-22 |
| 1003841842 | Gem Drugs, Inc. | Durable Medical Equipment & Medical Supplies | 139 Central Ave, Reserve, LA 70084 | 2006-07-11 |
| 1932645231 | Velissa Frank | Counselor | 279 Chad B Baker St, Reserve, LA 70084-5016 | 2017-01-10 |
| 1235774282 | Terri Millet | Non-emergency Medical Transport (VAN) | 365 E 22nd St, Reserve, LA 70084-5210 | 2019-11-14 |
| 1689170136 | Greater Living Care Center | Home Health | 395 E 22nd St, Reserve, LA 70084-5210 | 2018-04-03 |
| 1174918783 | Usa Pharmacy & Medical Supplies | Pharmacy | 1170 Highway 44, Reserve, LA 70084-5343 | 2015-03-31 |
| 1558811216 | Elizabeth Rousseve | Nurse Practitioner | 471 Central Ave, Reserve, LA 70084-5509 | 2016-10-06 |
| Find all providers in zip 70084 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255788428 | Teche Action Board, Inc. | Clinic/Center | 1 Wildcat Dr, Reserve, LA 70084-5800 | 2016-05-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.