Provencal Sbhc | |
132 Cherry St Provencal LA 71468 | |
(318) 472-8660 | |
(318) 472-8661 |
Full Name | Provencal Sbhc |
---|---|
Speciality | Clinic/center - Student Health |
Location | 132 Cherry St, Provencal, Louisiana |
Authorized Official Name and Position | Monte Wilson (CEO) |
Authorized Official Contact | 3374702100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Provencal Sbhc 3330 Masonic Dr Alexandria LA 71301-3841 Ph: (318) 483-4031 | Provencal Sbhc 132 Cherry St Provencal LA 71468 Ph: (318) 472-8660 |
NPI Number | 1164687307 |
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Provider Enumeration Date | 07/28/2008 |
Last Update Date | 10/19/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164687307 | NPI | - | NPPES |
1808814 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QS1000X | Clinic/center - Student Health | 234 (Louisiana) | Primary |
Access Health Louisiana Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 132 Cherry St, Provencal, LA 71468 Phone: 866-530-6111 |