| Fphsa Bogalusa Clinic | |
|
619 Willis Ave Bogalusa LA 70427-3001 | |
| (985) 732-6610 | |
| (985) 732-6626 |
| Full Name | Fphsa Bogalusa Clinic |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 619 Willis Ave, Bogalusa, Louisiana |
| Authorized Official Name and Position | Melanie Watkins (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9855434333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fphsa Bogalusa Clinic 619 Willis Ave Bogalusa LA 70427-3001 Ph: (985) 732-6610 | Fphsa Bogalusa Clinic 619 Willis Ave Bogalusa LA 70427-3001 Ph: (985) 732-6610 |
| NPI Number | 1447689930 |
|---|---|
| Provider Enumeration Date | 11/05/2013 |
| Last Update Date | 02/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447689930 | NPI | - | NPPES |
| 1710091 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 131 (Louisiana) | Primary |
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