NPIMap

Organization Active NPI

Teche Action Board Inc

Doing business as Teche Health @ Reserve

  • Federally Qualified Health Center (FQHC)
  • Reserve, LA
National Provider Identifier
1386880433
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TECHE ACTION BOARD INC
Doing business as
Teche Health @ Reserve
Practice address
471 Central Ave
Reserve, LA 70084-5509
Phone
(985) 479-1315
Fax
(985) 479-1328
NPI assigned
Dec 19, 2008
Last updated
Aug 11, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
TECHE ACTION BOARD, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

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

Authorized official

Name
Dr. Gary M Wiltz, MDNPI 1477596351
Title
Ceo
Phone
(337) 828-2550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X LA Primary

Addresses

Primary practice location

471 Central Ave
Reserve, LA 70084-5509

Mailing address

1115 Weber Street
Franklin, LA 70538-4124
Phone (337) 828-2550

Other names 1

  • Teche Health @ Reserve Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041109000792 LA Part B Supplier - Clinic/Group Practice 0648163980 Receives reassigned benefits from 39 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Place, LA; Vacherie, LA; Thibodaux, LA; Reserve, LA; Pierre Part, LA; Morgan City, LA; Houma, LA; Gramercy, LA…
O20091230000168 LA Part A Provider - Federally Qualified Health Center (FQHC) 0648163980 Practice locations: Reserve, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386880433. Details of each certification follow.

Federally qualified health center certification: CCN 191874

Legal name
TECHE ACTION BOARD INC
Doing business as
TECHE HEALTH @ RESERVE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 31, 2009
Last certification
Dec 31, 2009
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
471 Central Ave
Reserve, LA 70084-5509
Related CCNs
191801

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Teche Action Board Inc16 organizations share this tax ID, including this one
Part of
Teche Action Board Inc

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

159 E 3rd St
Edgard, LA 70049
Phone (985) 497-8726

1124 7th St
Morgan City, LA 70380
Phone (985) 384-2371

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Willie Rack Individual Corporate Director Dec 1, 2009
Howard Castay Individual Corporate Director Dec 1, 2009
Berryl Broussard Individual W-2 Managing EmployeeChief Legal Officier Apr 25, 2022
Thomas Dardar Individual Corporate Director Dec 1, 2009
Barbara Hills Individual Corporate Director Dec 1, 2009
Eugene Dial Individual Corporate Director Dec 1, 2009
Leroy Willis Individual Corporate Director Dec 1, 2009
Edna Lyons Individual Corporate Director Dec 1, 2009
Darrell Jupiter Individual Corporate Director Dec 1, 2009
Denise Pitts Individual Corporate Director Dec 1, 2009
Nikina Vilcan Individual Corporate Director Dec 1, 2009
W-2 Managing EmployeeCfo Aug 3, 2020
Rose Dorsey Individual Corporate Director Dec 1, 2009
Gary M Wiltz Individual Corporate OfficerCeo Dec 1, 2009
W-2 Managing Employee Dec 1, 2009
Donnie Frizzell Individual Corporate Director Dec 1, 2009
Athan J Olivier Individual W-2 Managing EmployeeCoo Apr 22, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1229644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1386880433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 WEBER STREET",
            "city": "FRANKLIN",
            "state": "LA",
            "postal_code": "705384124",
            "telephone_number": "337-828-2550",
            "fax_number": "337-355-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "471 CENTRAL AVE",
            "city": "RESERVE",
            "state": "LA",
            "postal_code": "700845509",
            "telephone_number": "985-479-1315",
            "fax_number": "985-479-1328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TECHE ACTION BOARD INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TECHE ACTION BOARD, INC.",
        "enumeration_date": "2008-12-19",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A",
        "authorized_official_last_name": "WILTZ",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-828-2550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teche Health @ Reserve",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reserve, LA

Sources for this page

Verify at the official NPI Registry.