TECHE ACTION BOARD, INC. (NPI# 1255788428) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255788428 |
| Entity Type | Organization |
| Organization Name | TECHE ACTION BOARD, INC. |
| Other Organization Name | TECHE ACTION CLINIC @ EAST ST. JOHN HIGH |
| Practice Address |
1 Wildcat Dr Reserve LA 70084-5800 |
| Mailing Address |
1115 Weber St Franklin LA 70538-4124 |
| Practice Telephone | 3378282550 |
| Practice Fax Number | 3373552335 |
| Mailing Telephone | 3378282550 |
| Mailing Fax Number | 3373552335 |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2016-10-18 |
| Authorized Official Name | DR. GARY M WILTZ (CEO) |
| Authorized Official Telephone | 3378282550 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 2426273 | 05 |
| Other Name | Type Code |
|---|---|
| Teche Action Clinic @ East St. John High | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912354176 | Teche Action Board, Inc. | Clinic/Center | 2555 La Hwy 18, Edgard, LA 70049-2417 | 2016-05-18 |
| 1215354014 | Teche Action Board, Inc. | Clinic/Center | 121 West 134th Place, Galliano, LA 70354 | 2014-03-19 |
| 1902082811 | Teche Action Board, Inc. | Clinic/Center | 18331 Highway 182, Baldwin, LA 70514-1449 | 2008-01-10 |
| 1154368553 | Teche Action Board, Inc. | Clinic/Center | 159 E 3rd St, Edgard, LA 70049-2450 | 2006-06-02 |
| 1215974019 | Teche Action Board, Inc. | Clinic/Center | 1014 West Tunnel Blvd, Houma, LA 70360-5555 | 2006-06-01 |
| 1760016562 | Teche Action Board, Inc. | Pharmacist | 1124 7th St, Morgan City, LA 70380 | 2020-03-02 |
| 1639702087 | Teche Action Board, Inc. | Pharmacy | 1124 7th St, Morgan City, LA 70380-1951 | 2020-02-13 |
| 1801433883 | Teche Action Board, Inc. | Clinic/Center | 827 N Pine St, Gramercy, LA 70052-3602 | 2019-12-09 |
| 1477900637 | Teche Action Board, Inc. | Clinic/Center | 393 Greenwood Dr, La Place, LA 70068-2535 | 2016-05-18 |
| 1396121117 | Teche Action Board, Inc. | Clinic/Center | 1124 7th St, Morgan City, LA 70380-1951 | 2015-08-04 |
| Street Address |
1 WILDCAT DR |
| City | RESERVE |
| State | LA |
| Zip Code | 70084-5800 |
| 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 |
|---|---|---|---|---|
| 1386880433 | Teche Action Board Inc | Clinic/Center | 473 Central Ave, Reserve, LA 70084-5509 | 2008-12-19 |
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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.