| Community Care Clinic Llc | |
|
5328 Cypress St West Monroe LA 71291-7506 | |
| (318) 397-3636 | |
| (318) 397-3639 |
| Full Name | Community Care Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5328 Cypress St, West Monroe, Louisiana |
| Authorized Official Name and Position | Jessica Bamburg Sharp (FAMILY NURSE PRACTITIONER- CO-OWNER) |
| Authorized Official Contact | 3183973636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Care Clinic Llc Po Box 2069 West Monroe LA 71294-2069 Ph: (318) 397-3636 | Community Care Clinic Llc 5328 Cypress St West Monroe LA 71291-7506 Ph: (318) 397-3636 |
| NPI Number | 1265671754 |
|---|---|
| Provider Enumeration Date | 02/06/2009 |
| Last Update Date | 02/06/2009 |
| Medicare PECOS PAC ID | 5597812719 |
|---|---|
| Medicare Enrollment ID | O20090406000011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265671754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | RN97721APO5017 (Louisiana) | Primary |
| 261QP2300X | Clinic/center - Primary Care | RN073699APO3572 (Louisiana) | Secondary |
| Provider Name | Roger W Rutledge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467487728 PECOS PAC ID: 4587670260 Enrollment ID: I20060306000103 |
| Provider Name | Ronald C Hubbard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427031640 PECOS PAC ID: 4183622863 Enrollment ID: I20061113000070 |
| Provider Name | Jessica B Sharp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629164280 PECOS PAC ID: 2466556592 Enrollment ID: I20070330000004 |
| Provider Name | Tejal Jetha |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134384613 PECOS PAC ID: 8921272758 Enrollment ID: I20111114000248 |
| Provider Name | Melissa D Futrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366823809 PECOS PAC ID: 7416260914 Enrollment ID: I20150713001698 |
| Provider Name | Stacy P Rutledge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174015002 PECOS PAC ID: 1254687569 Enrollment ID: I20180628002130 |
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