Teche Action Board Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Reserve, LA
NPI 1386880433 · NPPES record last updated Aug 11, 2025
Key facts
- NPI
- 1386880433
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- TECHE ACTION BOARD INC
- Practice address
- 471 Central Ave
Reserve, LA 70084-5509 - Phone
- (985) 479-1315
- Fax
- (985) 479-1328
- NPI assigned
- Dec 19, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- TECHE ACTION BOARD, INC.
Authorized official
- Name
- Dr. Gary M Wiltz, MD
- Title
- Ceo
- Phone
- (337) 828-2550
Owners & managing parties with NPI records 1
-
Gary M Wiltz, M.D.
Other NPIs on the same Medicare enrollment 17
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 14
Related certifications (CCN) 1
Practitioners 30
-
Carly Coyne, PHMNP-BC
-
Emily Geesling Bergeron, FNP-C
-
Richard Bergeron II, PMHNP, MSN
-
Alexis Bourgeois, PMHNP
-
Rebecca M Breaux, NP
-
Jill L Bueche, FNP
-
Mark Ellis, DPM
-
Lenny Anthony Folse, N.P.
-
Laura Duval Gros, PA-C
-
Carolyn Higdon, LPC
-
Shonda Lafaye Jackson, NURSE PRACTITIONER
-
Victor Jackson, M.D.
-
Kelsey Lynn Johnson, FNP
-
Tabitha D Luke, NP
-
Ronald C Marts, MD
-
Candice M Miller, NURSE PRACTITIONER
-
Lisa Oubre, DPM
-
Timothy J Pellegrin, PMHNP-BC
-
Brent J Rochon, MD
-
Suzanne R Simon, LPC
-
Bethanie Taylor Thibodaux, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in LA
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
- Corporation · Non-profit
- Enrollment address
- 471 Central Ave
Reserve, LA 70084-5509 - Related CCNs
- 191801
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Willie Rack |
Corporate Director | Dec 1, 2009 | |
| Howard Castay |
Corporate Director | Dec 1, 2009 | |
| Berryl Broussard |
W-2 Managing Employee |
Apr 25, 2022 | |
| Thomas Dardar |
Corporate Director | Dec 1, 2009 | |
| Barbara Hills |
Corporate Director | Dec 1, 2009 | |
| Eugene Dial |
Corporate Director | Dec 1, 2009 | |
| Leroy Willis |
Corporate Director | Dec 1, 2009 | |
| Edna Lyons |
Corporate Director | Dec 1, 2009 | |
| Darrell Jupiter |
Corporate Director | Dec 1, 2009 | |
| Denise Pitts |
Corporate Director | Dec 1, 2009 | |
| Nikina Vilcan |
Corporate Director | Dec 1, 2009 | |
| W-2 Managing Employee |
Aug 3, 2020 | ||
| Rose Dorsey |
Corporate Director | Dec 1, 2009 | |
| Gary M Wiltz |
Corporate Officer |
Dec 1, 2009 | |
| W-2 Managing Employee | Dec 1, 2009 | ||
| Donnie Frizzell |
Corporate Director | Dec 1, 2009 | |
| Athan J Olivier |
W-2 Managing Employee |
Apr 22, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Teche Action Clinic
- Part of
- Teche Action Clinic
Locations
189 Mozart Dr
Houma, LA 70363
Phone (985) 868-3700
5642 W Main St
Houma, LA 70360
Phone (985) 448-3737
22187 Highway 20
Vacherie, LA 70090
Phone (225) 258-4980
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | LA | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5B803 | Other | LA | MEDICARE PART B |
| 1803782 | Medicaid | LA |
Other names
- Teche Health @ Reserve
Other providers in Reserve, LA
- Amber Lynn Smith
- Southeast Louisiana Veterans Home
- Southeast Louisiana War Veterans Home
- Denis Hubert St. Pierre
- Sanjanette Burl Taylor
- Teche Action Board, Inc.
- Kelley Anne Thomas
- Koi Thompson
- USA Pharmacy & Medical Supplies
- Nancy Vairat
All providers in Reserve, LA · Federally Qualified Health Center (FQHC) in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.