| Health Paradigm, Llc | |
|
615 S Trenton St Ruston LA 71270-5040 | |
| (318) 251-2322 | |
| (318) 251-0710 |
| Full Name | Health Paradigm, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 615 S Trenton St, Ruston, Louisiana |
| Authorized Official Name and Position | Elisa M Vandenberg (ADMINISTRATOR) |
| Authorized Official Contact | 3182512322 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Health Paradigm, Llc 615 S Trenton St Ruston LA 71270-5040 Ph: (318) 251-2322 | Health Paradigm, Llc 615 S Trenton St Ruston LA 71270-5040 Ph: (318) 251-2322 |
| NPI Number | 1235340761 |
|---|---|
| Provider Enumeration Date | 05/25/2007 |
| Last Update Date | 09/01/2010 |
| Medicare PECOS PAC ID | 9133397524 |
|---|---|
| Medicare Enrollment ID | O20110801000173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235340761 | NPI | - | NPPES |
| 1681032 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | CI 3505 LA (Louisiana) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 1164R (Louisiana) | Primary |
| Provider Name | Herbert Vandenberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558397109 PECOS PAC ID: 1557302759 Enrollment ID: I20090928000148 |
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