NORTHLAKE MEDICINE AND WELLNESS CENTER LLC NPI 1073693958

NPI Information

NORTHLAKE MEDICINE AND WELLNESS CENTER, LLC is a primary care clinic center in Covington, LA. NORTHLAKE MEDICINE AND WELLNESS CENTER, LLC NPI is 1073693958. The provider is registered as an organization entity type.

The provider's business location address is:

1980 N HIGHWAY 190
COVINGTON, LA
ZIP 70433-158
Phone: (985) 809-6195
Fax: (985) 809-6199

The provider's authorized official is Tania Ann Levi .
The authorized official title is Owner and has the following contact phone number (985) 809-6195.

The CLIA number assigned to this NPI record is 19D1097436 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/16/2006 and was last updated on 8/16/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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