Colvin Medical Corporation | |
2106 Loop Rd Ste A Winnsboro LA 71295-3343 | |
(318) 435-8020 | |
Not Available |
Full Name | Colvin Medical Corporation |
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Speciality | Family Medicine |
Location | 2106 Loop Rd Ste A, Winnsboro, Louisiana |
Authorized Official Name and Position | Thomas L Colvin (OWNER) |
Authorized Official Contact | 3184356363 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Colvin Medical Corporation 2106 Loop Rd Ste A Winnsboro LA 71295-3343 Ph: (318) 435-6363 | Colvin Medical Corporation 2106 Loop Rd Ste A Winnsboro LA 71295-3343 Ph: (318) 435-8020 |
NPI Number | 1023152352 |
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Provider Enumeration Date | 02/19/2007 |
Last Update Date | 09/29/2022 |
Medicare PECOS PAC ID | 1254369846 |
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Medicare Enrollment ID | O20050804000021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023152352 | NPI | - | NPPES |
439928784A | Other | LA | BCBS OF LA PROVIDER NO |
1449571 | Medicaid | LA | |
1982670733 | Other | LA | INDIVIDUAL NPI NUMBER |
L92021 | Other | LA | VANTAGE PROVIDER NO |
4371062 | Other | LA | AETNA PROVIDER NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 109859 (Louisiana) | Primary |
Provider Name | Thomas L Colvin |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1982670733 PECOS PAC ID: 5799713384 Enrollment ID: I20050805000018 |
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