East Feliciana Primary Care Clinic | |
3050 Charles Dr Jackson LA 70748-6135 | |
(225) 634-3517 | |
(225) 635-5057 |
Full Name | East Feliciana Primary Care Clinic |
---|---|
Speciality | Internal Medicine |
Location | 3050 Charles Dr, Jackson, Louisiana |
Authorized Official Name and Position | Stacie N Nwabueze (ADMINISTRATOR) |
Authorized Official Contact | 2256343517 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
East Feliciana Primary Care Clinic 3050 Charles Dr Jackson LA 70748-6135 Ph: (225) 634-3517 | East Feliciana Primary Care Clinic 3050 Charles Dr Jackson LA 70748-6135 Ph: (225) 634-3517 |
NPI Number | 1114047735 |
---|---|
Provider Enumeration Date | 03/29/2007 |
Last Update Date | 07/06/2015 |
Medicare PECOS PAC ID | 8426019712 |
---|---|
Medicare Enrollment ID | O20041020000724 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114047735 | NPI | - | NPPES |
1552232 | Medicaid | LA | |
2330241 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | L12712R (Louisiana) | Primary |
208D00000X | General Practice | L12712R (Louisiana) | Secondary |
Provider Name | Nnamdi A Nwabueze |
---|---|
Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1871525667 PECOS PAC ID: 3577524867 Enrollment ID: I20041020000797 |
Jackson Complex Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3619 Highway 10, Jackson, LA 70748 Phone: 225-683-1360 Fax: 225-634-0005 |