| David Raines Community Health Center, Inc | |
|
441 Atlantic Ave Shreveport LA 71105-2911 | |
| (318) 723-7242 | |
| Not Available |
| Full Name | David Raines Community Health Center, Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 441 Atlantic Ave, Shreveport, Louisiana |
| Authorized Official Name and Position | Willie C White (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3187237242 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| David Raines Community Health Center, Inc 3041 Dr Martin Luther King Dr Shreveport LA 71107-4705 Ph: (318) 723-7242 | David Raines Community Health Center, Inc 441 Atlantic Ave Shreveport LA 71105-2911 Ph: (318) 723-7242 |
| NPI Number | 1144079872 |
|---|---|
| Provider Enumeration Date | 05/15/2024 |
| Last Update Date | 05/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144079872 | NPI | - | NPPES |
| 1941638 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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