| David Raines Community Health Center, Inc. | |
|
5904 W 70th St Shreveport LA 71129-2632 | |
| (318) 364-1750 | |
| Not Available |
| Full Name | David Raines Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 5904 W 70th St, Shreveport, Louisiana |
| Authorized Official Name and Position | Willie C White (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3182273342 |
| 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 Dr Martin Luther King Dr Shreveport LA 71107-4705 Ph: (318) 227-3350 | David Raines Community Health Center, Inc. 5904 W 70th St Shreveport LA 71129-2632 Ph: (318) 364-1750 |
| NPI Number | 1942083191 |
|---|---|
| Provider Enumeration Date | 08/14/2023 |
| Last Update Date | 08/14/2023 |
| Medicare PECOS PAC ID | 4688586118 |
|---|---|
| Medicare Enrollment ID | O20231101001890 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942083191 | 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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