Desoto Reginal Family Medicine - Logansport | |
808 Main Street Logansport LA 71049 | |
(318) 697-2273 | |
(318) 697-2277 |
Full Name | Desoto Reginal Family Medicine - Logansport |
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Speciality | Clinic/Center |
Location | 808 Main Street, Logansport, Louisiana |
Authorized Official Name and Position | Hallie Deutsch (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 3188713101 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Desoto Reginal Family Medicine - Logansport 808 Main Street Logansport LA 71049 Ph: (318) 697-2273 | Desoto Reginal Family Medicine - Logansport 808 Main Street Logansport LA 71049 Ph: (318) 697-2273 |
NPI Number | 1457489593 |
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Provider Enumeration Date | 03/01/2007 |
Last Update Date | 11/29/2023 |
Medicare PECOS PAC ID | 8022188176 |
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Medicare Enrollment ID | O20080602000779 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457489593 | NPI | - | NPPES |
1445932 | Medicaid | LA | |
5C630 | Other | LA | MDEICARE |
193448 | Other | LA | MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Louisiana) | Primary |
Provider Name | Melissa Richardson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1790750362 PECOS PAC ID: 3274603329 Enrollment ID: I20080602000798 |
Provider Name | Tiffany George |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760738801 PECOS PAC ID: 9739335647 Enrollment ID: I20120808000931 |
Provider Name | Angela Christine Taylor |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942650429 PECOS PAC ID: 7517250020 Enrollment ID: I20170425000658 |
Desoto Hospital Assocation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 808 Main St, Logansport, LA 71049 Phone: 318-697-2273 |