NPIMap

Organization Active NPI

Access Health Louisiana

Doing business as Tangipahoa Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Hammond, LA
National Provider Identifier
1790163715
Registry record updated Sep 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ACCESS HEALTH LOUISIANA
Doing business as
Tangipahoa Community Health Center
Practice address
42351 Phyllis Ann Dr
Hammond, LA 70403-1254
Phone
(985) 956-7406
Fax
(504) 575-3691
NPI assigned
May 11, 2015
Last updated
Sep 15, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2016

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

Authorized official

Name
Mark Keiser
Title
President
Phone
(504) 575-3700

Specialties & licenses 1

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

Addresses

Primary practice location

42351 Phyllis Ann Dr
Hammond, LA 70403-1254

Mailing address

2900 Indiana Ave
Kenner, LA 70065-4605
Phone (504) 575-3712

Other identifiers 1

IdentifierTypeStateIssuer
2396099MedicaidLA

Other names 1

  • Tangipahoa Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151002002277 LA Part A Provider - Federally Qualified Health Center (FQHC) 3678484276 Practice locations: Hammond, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790163715. Details of each certification follow.

Federally qualified health center certification: CCN 191934

Legal name
ACCESS HEALTH LOUISIANA
Doing business as
TANGIPAHOA CHC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 2, 2015
Last certification
Jul 2, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 21, 2002 in LA
Enrollment address
42351 Phyllis Ann Drive
Hammond, LA 70403-1254

National Provider Directory

National Provider Directory
Tax ID family
Access Health Louisiana89 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Peter Torsch Individual Corporate Director Nov 20, 2015
Gwendolyn Wade Individual Corporate Officer Apr 23, 2016
Estelle Alfortish Individual Corporate Officer Apr 23, 2018
Gaynell Alexander-Coleman Individual Corporate Officer Mar 1, 2003
Brooks Trotter Individual Corporate Officer Feb 24, 2011
Scott Falgoust Individual Corporate Officer May 31, 2018
Mark Francis Keiser Individual Corporate Director Mar 1, 2003
W-2 Managing Employee Mar 1, 2003
Sandra Zimmer Individual Corporate Officer Oct 25, 2018
John Cressend Schonberg Individual Corporate Officer Apr 23, 2009
Timothy J. Vial Individual Corporate Director Apr 23, 2010
Wendy Benedeto Individual Corporate Officer Apr 23, 2022

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St James Alternative School SBHCVacherie, LA, CCN 191087 Federally qualified health center Operational/Managerial Control Apr 1, 2003
Kenner Community Health CenterKenner, LA, CCN 191096 Federally qualified health center Operational/Managerial Control Apr 1, 2003
Luling Elementary School SBHCLuling, LA, CCN 191100 Federally qualified health center Operational/Managerial Control Apr 1, 2003
Destrehan HS SBHCDestrehan, LA, CCN 191104 Federally qualified health center Operational/Managerial Control Apr 1, 2003

NPI Registry JSON

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473897600000",
    "number": "1790163715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 INDIANA AVE",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700654605",
            "telephone_number": "504-575-3712",
            "fax_number": "504-575-3691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42351 PHYLLIS ANN DR",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704031254",
            "telephone_number": "985-956-7406",
            "fax_number": "504-575-3691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS HEALTH LOUISIANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-11",
        "last_updated": "2016-09-15",
        "status": "A",
        "authorized_official_last_name": "KEISER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "504-575-3700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2396099",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tangipahoa Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hammond, LA

Sources for this page

Verify at the official NPI Registry.