TECHE ACTION BOARD, INC. (NPI# 1912354176) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912354176 |
| Entity Type | Organization |
| Organization Name | TECHE ACTION BOARD, INC. |
| Other Organization Name | TECHE ACTION CLINIC @ WEST ST. JOHN ELEMENTARY |
| Practice Address |
2555 La Hwy 18 Edgard LA 70049-2417 |
| 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 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 | 2426419 | 05 |
| Other Name | Type Code |
|---|---|
| Teche Action Clinic @ West St. John Elementary | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1255788428 | Teche Action Board, Inc. | Clinic/Center | 1 Wildcat Dr, Reserve, LA 70084-5800 | 2016-05-18 |
| 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 |
2555 LA HWY 18 |
| City | EDGARD |
| State | LA |
| Zip Code | 70049-2417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144754318 | Destani Comminie | Counselor | 487 Castle Dr., Edgard, LA 70049 | 2017-04-14 |
| 1215409388 | Renee Jones | Driver | 399 E 6th St, Edgard, LA 70049-2331 | 2018-12-29 |
| 1518431873 | Renee Faith | Non-emergency Medical Transport (VAN) | 399 E 6th St, Edgard, LA 70049-2331 | 2019-01-18 |
| 1750826467 | Jonah Borne | Counselor | 300 E 5th St, Edgard, LA 70049-2354 | 2017-01-04 |
| 1710334057 | Lakeitha Ervin | Counselor | 2555 La Highway 18, Edgard, LA 70049-2417 | 2016-05-17 |
| 1023193364 | Sherry A Aucoin | Nurse Practitioner | 2555 Highway 18, Edgard, LA 70049-2417 | 2006-10-26 |
| 1154368553 | Teche Action Board, Inc. | Clinic/Center | 159 E 3rd St, Edgard, LA 70049-2450 | 2006-06-02 |
| 1255938924 | Christa Culpepper | Physician Assistant | 159 E 3rd St, Edgard, LA 70049-2450 | 2020-10-06 |
| 1699046359 | Roxie Hill | Family Medicine | 159 E 3rd St, Edgard, LA 70049-2450 | 2012-01-25 |
| 1588949341 | Tracey Renee Mattio | Nurse Practitioner | 159 E 3rd St, Edgard, LA 70049-2450 | 2011-10-12 |
| Find all providers in zip 70049 | ||||
| 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 |
|---|---|---|---|---|
| 1154368553 | Teche Action Board, Inc. | Clinic/Center | 159 E 3rd St, Edgard, LA 70049-2450 | 2006-06-02 |
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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.