| Desoto Regional Family Medicine - Mansfield | |
|
130 Jefferson St Mansfield LA 71052-2602 | |
| (318) 872-2700 | |
| (318) 872-6214 |
| Full Name | Desoto Regional Family Medicine - Mansfield |
|---|---|
| Speciality | Clinic/Center |
| Location | 130 Jefferson St, Mansfield, 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 |
|---|---|
| Desoto Regional Family Medicine - Mansfield 130 Jefferson St Mansfield LA 71052-2602 Ph: (318) 872-2700 | Desoto Regional Family Medicine - Mansfield 130 Jefferson St Mansfield LA 71052-2602 Ph: (318) 872-2700 |
| NPI Number | 1043359839 |
|---|---|
| Provider Enumeration Date | 02/06/2007 |
| Last Update Date | 03/27/2023 |
| Medicare PECOS PAC ID | 7719970599 |
|---|---|
| Medicare Enrollment ID | O20040412001175 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043359839 | NPI | - | NPPES |
| CN5547 | Other | LA | RR MEDICARE |
| 1948357 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Louisiana) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Benjamin L Leggio |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1851370332 PECOS PAC ID: 6507769916 Enrollment ID: I20040131000125 |
| Provider Name | James Harper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003808569 PECOS PAC ID: 0446141766 Enrollment ID: I20040324000479 |
| Provider Name | Lori Eubanks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982717716 PECOS PAC ID: 9931192713 Enrollment ID: I20040407000142 |
| Provider Name | Douglas C Sawyer |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1376577304 PECOS PAC ID: 2668450875 Enrollment ID: I20040713000464 |
| Provider Name | Chi Tai P Lau |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750340592 PECOS PAC ID: 9931167509 Enrollment ID: I20050311000626 |
| Provider Name | Gentry Lee Haughton |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1316171358 PECOS PAC ID: 1153592852 Enrollment ID: I20110928000471 |
| Provider Name | Denis F Kamberov |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932188422 PECOS PAC ID: 0941386882 Enrollment ID: I20111007000374 |
| Provider Name | Tiffany George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760738801 PECOS PAC ID: 9739335647 Enrollment ID: I20120808000931 |
| Provider Name | Stacey Leanne Dillard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710250204 PECOS PAC ID: 2365690864 Enrollment ID: I20131203001563 |
| Provider Name | Kimberly A Rials |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861841884 PECOS PAC ID: 5395033088 Enrollment ID: I20161012002142 |
| Provider Name | Larry D Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942660287 PECOS PAC ID: 4082987334 Enrollment ID: I20170907002321 |
| Provider Name | Brandon Javier Salgado |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710243340 PECOS PAC ID: 8820301898 Enrollment ID: I20180907001543 |
| Provider Name | Naishia L Pipkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881943637 PECOS PAC ID: 6103129101 Enrollment ID: I20180924000335 |
Desoto Regional Family Medicine-mansfield Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 130 Jefferson St, Mansfield, LA 71052 Phone: 318-872-2700 Fax: 318-872-6214 | |
Casse Community Health Institute Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 907 Polk St, Mansfield, LA 71052 Phone: 318-872-1015 Fax: 318-872-1055 | |
Just Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 Franklin St, Mansfield, LA 71052 Phone: 318-872-3956 | |
Casse/community Health Institute Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 907 Polk St, Mansfield, LA 71052 Phone: 318-872-1015 Fax: 318-872-1055 | |
Community Health Institute Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 907 Polk St, Mansfield, LA 71052 Phone: 318-872-1015 Fax: 318-872-1055 | |
Just Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 208 Adams St, Mansfield, LA 71052 Phone: 833-784-2669 Fax: 844-784-2329 |