| |
5159 Highway 4 E Columbia LA 71418-3580 | |
(318) 649-2333 | |
(318) 649-0149 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 5159 Highway 4 E, Columbia, Louisiana |
Authorized Official Name and Position | Octavia Green (ADMINISTRATIVE PROGRAM SPECIALIST B) |
Authorized Official Contact | 3183623270 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5159 Highway 4 E Columbia LA 71418-3580 Ph: (318) 649-2333 | 5159 Highway 4 E Columbia LA 71418-3580 Ph: (318) 649-2333 |
NPI Number | 1467106344 |
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Provider Enumeration Date | 02/09/2022 |
Last Update Date | 08/30/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467106344 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
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