| Country Clinic, Llc | |
|
314 Christine Ln Simmesport LA 71369-2256 | |
| (318) 941-2057 | |
| (318) 941-2067 |
| Full Name | Country Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 314 Christine Ln, Simmesport, Louisiana |
| Authorized Official Name and Position | Rose Kuplesky (OWNER/MANAGER) |
| Authorized Official Contact | 3189412057 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Country Clinic, Llc Po Box 80735 Lafayette LA 70598-0735 Ph: (800) 564-8971 | Country Clinic, Llc 314 Christine Ln Simmesport LA 71369-2256 Ph: (318) 941-2057 |
| NPI Number | 1609825892 |
|---|---|
| Provider Enumeration Date | 05/08/2006 |
| Last Update Date | 11/13/2014 |
| Medicare PECOS PAC ID | 4082936372 |
|---|---|
| Medicare Enrollment ID | O20141121001438 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609825892 | NPI | - | NPPES |
| 1445665 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 025398 (Louisiana) | Primary |
| Provider Name | Gordon E White Ii |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639169485 PECOS PAC ID: 8426957317 Enrollment ID: I20040108000897 |
| Provider Name | Christopher L Surek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336119858 PECOS PAC ID: 9032148580 Enrollment ID: I20050805000141 |
Kd Health & Wellness Center Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 118 Jjj Ln, Simmesport, LA 71369 Phone: 318-941-5286 Fax: 318-941-5284 | |
Newell E. Gauthier Jr. Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 417 North Mlk Drive, Simmesport, LA 71369 Phone: 318-941-2336 Fax: 318-941-2388 | |
Simmesport Family Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 417 N Martin Luther King Dr, Simmesport, LA 71369 Phone: 800-462-0742 Fax: 318-941-2388 | |
Kd Health & Wellness Center Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 118 Jjj Ln, Simmesport, LA 71369 Phone: 318-941-5287 Fax: 318-941-5284 |