NPIMap

Organization Active NPI

Mmo of Gonzales, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gonzales, LA
National Provider Identifier
1093883522
Registry record updated Jul 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
531032 Issued in LA
Legal business name
MMO OF GONZALES, LLC
Practice address
305 South Burnside Ave.
Suite D
Gonzales, LA 70737
Phone
(225) 621-2760
Fax
(225) 621-2768
NPI assigned
Dec 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Robert L. Miller
Title
Ceo
Phone
(225) 293-6774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 531032 LA Primary

Addresses

Primary practice location

305 South Burnside Ave.
Suite D
Gonzales, LA 70737

Mailing address

728 North Blvd
Baton Rouge, LA 70802-5724
Phone (225) 621-2760

Other names 1

  • On Track Community Health Center LLC dbaSilver Options Center On-Track Former legal business name

National Provider Directory

National Provider Directory

Locations

728 North Blvd
Baton Rouge, LA 70802
Phone (225) 293-6774

305 S Burnside Ave
Gonzales, LA 70737
Phone (225) 621-2760

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278028800000",
    "number": "1093883522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "728 NORTH BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708025724",
            "telephone_number": "225-621-2760",
            "fax_number": "225-621-2768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 SOUTH BURNSIDE AVE.",
            "address_2": "SUITE D",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "70737",
            "telephone_number": "225-621-2760",
            "fax_number": "225-621-2768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMO OF GONZALES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2010-07-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-293-6774",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "LA",
            "license": "531032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "On Track Community Health Center LLC dbaSilver Options Center On-Track",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Gonzales, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.