NPIMap

Organization Active NPI

Teche Action Board, Inc.

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

  • Federally Qualified Health Center (FQHC)
  • Baldwin, LA
National Provider Identifier
1902082811
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 SBHC @ West St. Mary H.S
Practice address
18333 Highway 182 RM 505
Baldwin, LA 70514-1449
Phone
(337) 924-9418
Fax
(337) 924-9165
NPI assigned
Jan 10, 2008
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, M.D.NPI 1477596351
Title
Ceo
Phone
(337) 828-2550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

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 names 1

  • Teche Health SBHC @ West St. Mary H.S 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…
O20091230000218 LA Part A Provider - Federally Qualified Health Center (FQHC) 0648163980 Practice locations: Baldwin, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902082811. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
18333 Highway 182
RM 505
Baldwin, LA 70514-1449

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

Ownership & related parties

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 DirectorBoard Member Apr 10, 2014
Howard Castay Individual Corporate Director Dec 1, 2009
Berryl Broussard Individual W-2 Managing EmployeeChief Legal Officer May 3, 2021
Thomas Dardar Individual Corporate Director Dec 1, 2009
Barbara Hills Individual Corporate OfficerSecretary Dec 1, 2009
Eugene Dial Individual Corporate Director Dec 1, 2009
Leroy Willis Individual Corporate OfficerPresident 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 EmployeeCfo Aug 3, 2020
Rose Dorsey Individual Corporate OfficerTreasurer Apr 10, 2014
Gary M Wiltz Individual W-2 Managing EmployeeCeo Dec 1, 2009
Operational/Managerial Control Dec 1, 2009
Donnie Frizzell Individual Corporate Director Dec 1, 2009
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 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1902082811",
    "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": "337-355-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18333 HIGHWAY 182 RM 505",
            "city": "BALDWIN",
            "state": "LA",
            "postal_code": "705141449",
            "telephone_number": "337-924-9418",
            "fax_number": "337-924-9165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TECHE ACTION BOARD, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TECHE ACTION BOARD, INC.",
        "enumeration_date": "2008-01-10",
        "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": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teche Health SBHC @ West St. Mary H.S",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baldwin, LA

Sources for this page

Verify at the official NPI Registry.