| David Raines Community Health Center, Inc. | |
|
4331 Henry St Shreveport LA 71109-6820 | |
| (318) 635-2141 | |
| Not Available |
| Full Name | David Raines Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4331 Henry St, Shreveport, Louisiana |
| Authorized Official Name and Position | Willie C. White (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3182273350 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David Raines Community Health Center, Inc. 3041 Martin Luther King Jr. Drive Shreveport LA 71107-5899 Ph: (318) 227-3350 | David Raines Community Health Center, Inc. 4331 Henry St Shreveport LA 71109-6820 Ph: (318) 635-2141 |
| NPI Number | 1760042394 |
|---|---|
| Provider Enumeration Date | 06/17/2019 |
| Last Update Date | 06/17/2019 |
| Medicare PECOS PAC ID | 4688586118 |
|---|---|
| Medicare Enrollment ID | O20231114000305 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760042394 | 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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