Dry Prong Family Clinic | |
800 Grove Street Dry Prong LA 71423 | |
(318) 568-8298 | |
(318) 568-8297 |
Full Name | Dry Prong Family Clinic |
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Speciality | Clinic/Center |
Location | 800 Grove Street, Dry Prong, Louisiana |
Authorized Official Name and Position | Benjamin Colvin (OWNER) |
Authorized Official Contact | 3185688298 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Dry Prong Family Clinic Po Box 37 Montgomery LA 71454-0037 Ph: () - | Dry Prong Family Clinic 800 Grove Street Dry Prong LA 71423 Ph: (318) 568-8298 |
NPI Number | 1366928277 |
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Provider Enumeration Date | 07/13/2018 |
Last Update Date | 06/02/2020 |
Medicare PECOS PAC ID | 1759631591 |
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Medicare Enrollment ID | O20180829001047 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366928277 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Benjamin J Colvin |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730425281 PECOS PAC ID: 9335374586 Enrollment ID: I20131024001527 |
Provider Name | Casey V Hebert |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477969228 PECOS PAC ID: 0244554517 Enrollment ID: I20150114000913 |
Provider Name | Gayle Elliott |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861988537 PECOS PAC ID: 2365792116 Enrollment ID: I20180829001699 |
Provider Name | Amy W Brewer |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124758081 PECOS PAC ID: 9830566710 Enrollment ID: I20221107000085 |
Provider Name | Jessica L Fowler |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578205829 PECOS PAC ID: 6406209089 Enrollment ID: I20240131000425 |
Grant Sbhc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17763 Highway 167, Dry Prong, LA 71423 Phone: 318-899-5276 Fax: 318-899-5932 | |
Access Health Louisiana Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 17763 Highway 167, Dry Prong, LA 71423 Phone: 866-530-6111 | |
Winn Community Health Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 21239 Highway 167, Dry Prong, LA 71423 Phone: 318-648-0375 |