NPIMap

Organization Active NPI

Teche Action Board, Inc.

Doing business as Teche Health @ Gramercy

  • Federally Qualified Health Center (FQHC)
  • Gramercy, LA
National Provider Identifier
1801433883
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 @ Gramercy
Practice address
827 N Pine St
Gramercy, LA 70052-3602
Phone
(337) 828-2550
Fax
(337) 355-2333
NPI assigned
Dec 9, 2019
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 connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

827 N Pine St
Gramercy, LA 70052-3602

Mailing address

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

Other names 1

  • Teche Health @ Gramercy 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…
O20230413000056 LA Part A Provider - Federally Qualified Health Center (FQHC) 0648163980 Practice locations: Gramercy, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801433883. Details of each certification follow.

Federally qualified health center certification: CCN 191118

Legal name
TECHE ACTION BOARD INC
Doing business as
TECHE HEALTH @ GRAMERCY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 10, 2023
Last certification
Apr 10, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 8, 2020 in LA
Enrollment address
827 N Pine St
Gramercy, LA 70052-3602

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

393 Greenwood Dr
La Place, LA 70068
Phone (985) 359-6492

Ownership & related parties

All disclosed owners & managing parties 16

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 DirectorBoard Member Jan 8, 2020
Shannon Verdun Individual W-2 Managing EmployeeHR Privileging & Cred. Manager Jan 8, 2020
Howard Castay Individual Corporate DirectorBoard Member Jan 8, 2020
Berryl Broussard Individual W-2 Managing EmployeeChief Legal Officier Jan 8, 2020
Thomas Dardar Individual Corporate DirectorBoard Member Jan 8, 2020
Barbara Hills Individual Corporate OfficerSecretary Jan 8, 2020
Eugene Dial Individual Corporate DirectorBoard Member Jan 8, 2020
Leroy Willis Individual Corporate OfficerPresident Jan 8, 2020
Edna Lyons Individual Corporate DirectorBoard Member Jan 8, 2020
Darrell Jupiter Individual Corporate DirectorBoard Member Jan 8, 2020
Denise Pitts Individual Corporate DirectorBoard Member Jan 8, 2020
Nikina Vilcan Individual W-2 Managing EmployeeCfo Mar 16, 2020
Rose Dorsey Individual Corporate OfficerTreasurer Jan 8, 2020
Gary M Wiltz Individual W-2 Managing EmployeeCep Jan 8, 2020
Operational/Managerial ControlCeo Jan 8, 2020
Donnie Frizzell Individual Corporate DirectorBoard Member Jan 8, 2020
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 33

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.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1575849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1801433883",
    "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": "827 N PINE ST",
            "city": "GRAMERCY",
            "state": "LA",
            "postal_code": "700523602",
            "telephone_number": "337-828-2550",
            "fax_number": "337-355-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TECHE ACTION BOARD, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TECHE ACTION BOARD, INC.",
        "enumeration_date": "2019-12-09",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teche Health @ Gramercy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gramercy, LA

Sources for this page

Verify at the official NPI Registry.