Full Name | |
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Speciality | Psychiatric Unit |
Location | 108 6th Ave, Kinder, Louisiana |
Authorized Official Name and Position | Jacqueline Reviel (CEO) |
Authorized Official Contact | 3377389479 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
108 6th Ave Kinder LA 70648-3187 Ph: (337) 738-9489 | 108 6th Ave Kinder LA 70648-3187 Ph: (337) 738-9489 |
NPI Number | 1982601944 |
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Provider Enumeration Date | 07/06/2005 |
Last Update Date | 12/06/2022 |
Certification Date | 12/06/2022 |
Medicare PECOS PAC ID | 3274431341 |
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Medicare Enrollment ID | O20031229000092 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982601944 | NPI | - | NPPES |
1734691 | Medicaid | LA | |
2029938 | Other | PK | |
1705268 | Medicaid | LA | |
1914236 | Other | COMMERCIAL |
Provider Name | Chukwudi B Uchendu |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1912959453 PECOS PAC ID: 2961464979 Enrollment ID: I20041102000485 |
Provider Name | Monty N Heinen |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1538263728 PECOS PAC ID: 8426099482 Enrollment ID: I20050519000671 |
Provider Name | Ejiro E Ughovwa |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1770521536 PECOS PAC ID: 6709815483 Enrollment ID: I20050812000237 |
Provider Name | Douglas Matthew Casey |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1942498613 PECOS PAC ID: 3870674914 Enrollment ID: I20080115000623 |
Provider Name | Brenton W Mcdonald |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1528094455 PECOS PAC ID: 1254417132 Enrollment ID: I20080319000043 |
Provider Name | Sandy F Leger |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1083609937 PECOS PAC ID: 2769552389 Enrollment ID: I20080609000140 |
Provider Name | William Mask |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1215030507 PECOS PAC ID: 2264452457 Enrollment ID: I20080722000445 |
Provider Name | William M Wilder |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1730120312 PECOS PAC ID: 6406872134 Enrollment ID: I20090520000335 |
Provider Name | Marcus V Stelly |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1225206212 PECOS PAC ID: 1759412554 Enrollment ID: I20100623000074 |
Provider Name | Chad T Porter |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1669652665 PECOS PAC ID: 0547391229 Enrollment ID: I20100624000002 |
Provider Name | Matthew Courville |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1548584550 PECOS PAC ID: 2264602127 Enrollment ID: I20110901000045 |
Provider Name | Rex Brown |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1871867713 PECOS PAC ID: 4183884612 Enrollment ID: I20120321000106 |
Provider Name | Brett R Travis |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1700082682 PECOS PAC ID: 5698917086 Enrollment ID: I20130814000856 |
Provider Name | Ralph L Abraham |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1639346174 PECOS PAC ID: 2365686391 Enrollment ID: I20130913000109 |
Provider Name | Morgan Cheatham Haile |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1760655500 PECOS PAC ID: 6901060292 Enrollment ID: I20140127001269 |
Provider Name | Michael P England |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598171241 PECOS PAC ID: 6103046636 Enrollment ID: I20141006001703 |
Provider Name | Justin Hung Pham |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1821040866 PECOS PAC ID: 0042104754 Enrollment ID: I20141022000483 |
Provider Name | Roberto Rivera-morales |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1992797377 PECOS PAC ID: 6002713336 Enrollment ID: I20141105002701 |
Provider Name | William Betz |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1720040389 PECOS PAC ID: 7214905876 Enrollment ID: I20141121001043 |
Provider Name | Matthew K Dang |
---|---|
Provider Type | Practitioner - Interventional Radiology |
Provider Identifiers | NPI Number: 1588848857 PECOS PAC ID: 7517131147 Enrollment ID: I20150130000807 |
Provider Name | Richard Andrew Levy |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1891184883 PECOS PAC ID: 3779800172 Enrollment ID: I20150324001282 |
Provider Name | Jessica D Caraway |
---|---|
Provider Type | Practitioner - Interventional Radiology |
Provider Identifiers | NPI Number: 1710120274 PECOS PAC ID: 6103130463 Enrollment ID: I20150730011487 |
Provider Name | Alex J Courville |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1578983367 PECOS PAC ID: 3274759279 Enrollment ID: I20160120002059 |
Provider Name | Dennis Burton |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1043298417 PECOS PAC ID: 7416857388 Enrollment ID: I20170207001230 |
Provider Name | Pradheep Jothi Shanker |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1457399818 PECOS PAC ID: 8123030657 Enrollment ID: I20170227000231 |
Provider Name | Jason R Trahan |
---|---|
Provider Type | Practitioner - Otolaryngology |
Provider Identifiers | NPI Number: 1568704328 PECOS PAC ID: 7911262209 Enrollment ID: I20180608000298 |
Provider Name | Elliott Wagner |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1558312579 PECOS PAC ID: 7416856745 Enrollment ID: I20190801001127 |
Provider Name | Melanie Clark |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1164692711 PECOS PAC ID: 5294805503 Enrollment ID: I20210528001661 |
Provider Name | David Owens |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1932284833 PECOS PAC ID: 4284546987 Enrollment ID: I20210603000796 |
Provider Name | Michelle Goni |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1235114760 PECOS PAC ID: 4284642281 Enrollment ID: I20210608001704 |
Provider Name | Naiyer Imam |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1992768147 PECOS PAC ID: 6103880935 Enrollment ID: I20210622000106 |
Provider Name | Abbas A Chamsuddin |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1578539557 PECOS PAC ID: 0446150262 Enrollment ID: I20210622000844 |
Provider Name | Sanjay Jain |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1730130105 PECOS PAC ID: 7911804968 Enrollment ID: I20210622002747 |
Provider Name | Allissa K Joseph |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1487179818 PECOS PAC ID: 7618240219 Enrollment ID: I20211013000783 |
Provider Name | Stephen Johnston |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1730525841 PECOS PAC ID: 0042574048 Enrollment ID: I20220307000090 |
Provider Name | Michael Rolen |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1730316118 PECOS PAC ID: 8022330893 Enrollment ID: I20220819001219 |
Provider Name | Sameh Sakla |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1518250307 PECOS PAC ID: 5294080230 Enrollment ID: I20220824003695 |
Provider Name | Lloyd Wagner |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1124161872 PECOS PAC ID: 3870517923 Enrollment ID: I20220922000926 |
Provider Name | Aamer Farooki |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1316941859 PECOS PAC ID: 5698768539 Enrollment ID: I20221017001292 |
Provider Name | Nicholas Kramer |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1780118026 PECOS PAC ID: 1850767542 Enrollment ID: I20221020002678 |
Provider Name | Palam Annamalai |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1972529584 PECOS PAC ID: 5698776144 Enrollment ID: I20221026000445 |
Provider Name | Kaylyn Ann Cooley |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275268807 PECOS PAC ID: 2365825668 Enrollment ID: I20221123000417 |
Provider Name | Morgan Harmon |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457057036 PECOS PAC ID: 7315302619 Enrollment ID: I20230419003114 |
Provider Name | Richard Knight |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1740239094 PECOS PAC ID: 7315046190 Enrollment ID: I20230615004070 |
Provider Name | Caleb Ruben Rivera |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1164410916 PECOS PAC ID: 5496791857 Enrollment ID: I20240308002322 |
Provider Name | Rolando Ernesto Prieto |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1578551321 PECOS PAC ID: 7416993860 Enrollment ID: I20240312001116 |
Provider Name | Marshall Lamont Harmon |
---|---|
Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1396492807 PECOS PAC ID: 6608214267 Enrollment ID: I20240402003631 |
Provider Name | Ryan Keith Tompkins |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1619064623 PECOS PAC ID: 1052493152 Enrollment ID: I20240416002479 |
Provider Name | Ronald Regan Winters |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1437593779 PECOS PAC ID: 8123382397 Enrollment ID: I20240503001227 |
Provider Name | Matthew Smith |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1275869729 PECOS PAC ID: 6103148127 Enrollment ID: I20240513000864 |
Provider Name | Christopher Bazemore |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1265813760 PECOS PAC ID: 5395137459 Enrollment ID: I20240806004353 |
Provider Name | Katherine Guillory |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285460410 PECOS PAC ID: 2466986468 Enrollment ID: I20241113003757 |
Provider Name | Jennifer Benjamin |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1255473310 PECOS PAC ID: 6305831264 Enrollment ID: I20241113004288 |
Provider Name | Wendell Scott Morgan |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1124167671 PECOS PAC ID: 0042371387 Enrollment ID: I20241126002239 |