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2932 Stagg Ave Ste A Basile LA 70515-5560 | |
(337) 432-5552 | |
(337) 432-5553 |
Full Name | |
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Speciality | Clinic/center |
Location | 2932 Stagg Ave, Basile, Louisiana |
Authorized Official Name and Position | Jena Miller Roy (OWNER) |
Authorized Official Contact | 3374325552 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2932 Stagg Ave Ste A Basile LA 70515-5560 Ph: (337) 432-5552 | 2932 Stagg Ave Ste A Basile LA 70515-5560 Ph: (337) 432-5552 |
NPI Number | 1265710982 |
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Provider Enumeration Date | 07/29/2011 |
Last Update Date | 10/10/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265710982 | NPI | - | NPPES |
2116479 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | AP06059 (Louisiana) | Primary |