| Methodist Health System Foundation, Inc | |
|
1100 E Judge Perez Dr Chalmette LA 70043-5405 | |
| (504) 333-6988 | |
| (504) 342-2184 |
| Full Name | Methodist Health System Foundation, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1100 E Judge Perez Dr, Chalmette, Louisiana |
| Authorized Official Name and Position | Wendy M. Beron (PRESIDENT) |
| Authorized Official Contact | 9857269333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Methodist Health System Foundation, Inc 360 Oak Harbor Blvd Slidell LA 70458-5702 Ph: (985) 726-9333 | Methodist Health System Foundation, Inc 1100 E Judge Perez Dr Chalmette LA 70043-5405 Ph: (504) 333-6988 |
| NPI Number | 1093846354 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 03/11/2022 |
| Medicare PECOS PAC ID | 2668449786 |
|---|---|
| Medicare Enrollment ID | O20210208000533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093846354 | NPI | - | NPPES |
| 1039691 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |
| Provider Name | Patrick E Mottram |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962471177 PECOS PAC ID: 3577462746 Enrollment ID: I20060222000394 |
| Provider Name | Glenda Gant-london |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851486922 PECOS PAC ID: 4284732496 Enrollment ID: I20070612000743 |
| Provider Name | Heather Surcouf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619978541 PECOS PAC ID: 5496169260 Enrollment ID: I20210208000625 |
| Provider Name | Audra Degan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760820138 PECOS PAC ID: 9931513702 Enrollment ID: I20210208000653 |
| Provider Name | Ailenne Coulon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013412444 PECOS PAC ID: 1658785423 Enrollment ID: I20210208000679 |
| Provider Name | Katherine S Grieshaber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093065732 PECOS PAC ID: 7517314925 Enrollment ID: I20231107001511 |
| Provider Name | Jamesalina M Tyus |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215410923 PECOS PAC ID: 9638320526 Enrollment ID: I20231208001623 |
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