NPIMap

Teche Action Board, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Baldwin, LA

NPI 1902082811 · NPPES record last updated Aug 11, 2025

Key facts

NPI
1902082811
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
TECHE ACTION BOARD, INC.
Practice address
18333 Highway 182 RM 505
Baldwin, LA 70514-1449
Phone
(337) 924-9418
Fax
(337) 924-9165
NPI assigned
Jan 10, 2008
Organization subpart
Yes
Parent organization (as reported)
TECHE ACTION BOARD, INC.

Authorized official

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

Owners & managing parties with NPI records 1

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

  • Gary M Wiltz, M.D. Internal Medicine Physician · Franklin, LA · NPI 1477596351
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL · W-2 MANAGING EMPLOYEE

Other NPIs on the same Medicare enrollment 17

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

Other NPIs with the same Medicare PAC ID 11

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

Corporate family (same tax ID) 14

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

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in LA

Federally qualified health center certification: CCN 191873

Legal name
TECHE ACTION BOARD INC
Doing business as
TECHE HEALTH SBHC @WEST ST MARY H.S
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 – corporation
Organization structure
Corporation · Non-profit
Enrollment address
18333 Highway 182
RM 505
Baldwin, LA 70514-1449

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
Board Member		 Apr 10, 2014
Howard Castay
Individual 		Corporate Director Dec 1, 2009
Berryl Broussard
Individual 		W-2 Managing Employee
Chief Legal Officer		 May 3, 2021
Thomas Dardar
Individual 		Corporate Director Dec 1, 2009
Barbara Hills
Individual 		Corporate Officer
Secretary		 Dec 1, 2009
Eugene Dial
Individual 		Corporate Director Dec 1, 2009
Leroy Willis
Individual 		Corporate Officer
President		 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 		W-2 Managing Employee
Cfo		 Aug 3, 2020
Rose Dorsey
Individual 		Corporate Officer
Treasurer		 Apr 10, 2014
Gary M Wiltz
Individual 		W-2 Managing Employee
Ceo		 Dec 1, 2009
Operational/Managerial Control Dec 1, 2009
Donnie Frizzell
Individual 		Corporate Director Dec 1, 2009
Athan J Olivier
Individual 		W-2 Managing Employee
Coo		 Apr 22, 2025

Medicare enrollment records

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…
O20091230000218 LA Part a Provider - Federally Qualified Health Center (FQHC) 0648163980 Practice locations: Baldwin, LA

National Provider Directory

Tax ID family
Teche Action Clinic (15 organizations share this tax ID)
Part of
Teche Action Clinic

Locations

809 W Tunnel Blvd
Houma, LA 70360
Phone (985) 851-1717

Specialties & licenses

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

Addresses

Primary practice location

18333 Highway 182 RM 505
Baldwin, LA 70514-1449

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
1908347MedicaidLA

Other names

  • Teche Health SBHC @ West St. Mary H.S Doing business as

Other providers in Baldwin, LA

All providers in Baldwin, LA · Federally Qualified Health Center (FQHC) in Louisiana

Sources for this page

Verify at the official NPI Registry.