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501 Front St Cheneyville LA 71325-0385 | |
(318) 279-2300 | |
(318) 279-2302 |
Full Name | |
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Speciality | Clinic/Center |
Location | 501 Front St, Cheneyville, Louisiana |
Authorized Official Name and Position | Cora R Chenevert (CEO/OWNER) |
Authorized Official Contact | 3182792300 |
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 385 Cheneyville LA 71325-0385 Ph: (318) 279-2300 | 501 Front St Cheneyville LA 71325-0385 Ph: (318) 279-2300 |
NPI Number | 1811381072 |
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Provider Enumeration Date | 03/26/2015 |
Last Update Date | 04/21/2022 |
Medicare PECOS PAC ID | 9931409950 |
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Medicare Enrollment ID | O20151124000905 |
Identifier | Type | State | Issuer |
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1811381072 | NPI | - | NPPES |
2338773 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | AP07392 (Louisiana) | Primary |
Provider Name | Cora R Chenevert |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497193528 PECOS PAC ID: 2567697782 Enrollment ID: I20131024000657 |