| David Raines School Based Health Center-js Clark | |
|
351 Hearne Ave Shreveport LA 71103-2019 | |
| (318) 425-8742 | |
| Not Available |
| Full Name | David Raines School Based Health Center-js Clark |
|---|---|
| Speciality | Clinic/Center |
| Location | 351 Hearne Ave, 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 School Based Health Center-js Clark 3041 Martin Luther King Drive Shreveport LA 71107-4705 Ph: (318) 227-3350 | David Raines School Based Health Center-js Clark 351 Hearne Ave Shreveport LA 71103-2019 Ph: (318) 425-8742 |
| NPI Number | 1437673464 |
|---|---|
| Provider Enumeration Date | 08/01/2017 |
| Last Update Date | 08/01/2017 |
| Medicare PECOS PAC ID | 4688586118 |
|---|---|
| Medicare Enrollment ID | O20231102001758 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437673464 | 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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