Teche Action Board, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

TECHE ACTION BOARD, INC.

Practice address

1020 Saadi St
Houma, LA 70363-6748

Phone

(985) 876-8465

Fax

(985) 876-8466

NPI assigned

Dec 14, 2022

Organization subpart

Yes

Parent organization

TECHE ACTION BOARD, INC.As reported in NPPES

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

Authorized official

Name

Dr. Gary M Wiltz, MD

Title

Ceo

Phone

(337) 828-2550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Teche Action Clinic @ Acadian Elementary School Doing business as

Part of

Teche Action Clinic

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

{
    "created_epoch": "1670976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1427760149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 WEBER ST",
            "city": "FRANKLIN",
            "state": "LA",
            "postal_code": "705384124",
            "telephone_number": "337-828-2550",
            "fax_number": "337-355-2333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 SAADI ST",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703636748",
            "telephone_number": "985-876-8465",
            "fax_number": "985-876-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TECHE ACTION BOARD, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TECHE ACTION BOARD, INC.",
        "enumeration_date": "2022-12-14",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "5B803",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teche Action Clinic @ Acadian Elementary School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Houma, LA
• Federally Qualified Health Center (FQHC) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.