Full Name | |
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Speciality | Clinic/Center |
Location | 9465 Us Hwy 165, Pollock, Louisiana |
Authorized Official Name and Position | Deano Thornton (CEO) |
Authorized Official Contact | 3186480375 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1288 Winnfield LA 71483-1288 Ph: (318) 648-0375 | 9465 Us Hwy 165 Pollock LA 71467 Ph: (318) 627-5021 |
NPI Number | 1982132189 |
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Provider Enumeration Date | 06/01/2017 |
Last Update Date | 07/20/2022 |
Certification Date | 07/20/2022 |
Medicare PECOS PAC ID | 2567516545 |
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Medicare Enrollment ID | O20170928000094 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982132189 | NPI | - | NPPES |