| Edwin R. Bonilla, M.d. | |
|
403 W 8th St Deridder LA 70634-5507 | |
| (337) 463-8977 | |
| (337) 462-3093 |
| Full Name | Edwin R. Bonilla, M.d. |
|---|---|
| Speciality | Clinic/Center |
| Location | 403 W 8th St, Deridder, Louisiana |
| Authorized Official Name and Position | Darrell L Kingham (CFO) |
| Authorized Official Contact | 3374627111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edwin R. Bonilla, M.d. Po Box 935 Deridder LA 70634-0935 Ph: (337) 463-8977 | Edwin R. Bonilla, M.d. 403 W 8th St Deridder LA 70634-5507 Ph: (337) 463-8977 |
| NPI Number | 1982017273 |
|---|---|
| Provider Enumeration Date | 06/04/2014 |
| Last Update Date | 06/04/2014 |
| Medicare PECOS PAC ID | 8729208830 |
|---|---|
| Medicare Enrollment ID | O20141011000004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982017273 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Edwin R Bonilla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891806121 PECOS PAC ID: 7012191208 Enrollment ID: I20110413000231 |
| Provider Name | Jonathon D Sossamon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114304375 PECOS PAC ID: 4385932169 Enrollment ID: I20180730000632 |
Imperial Health Llp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 W 5th St, Deridder, LA 70634 Phone: 337-202-7850 | |
Davenport Family Medical Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 W 6th St, Deridder, LA 70634 Phone: 337-460-0690 Fax: 337-460-0961 | |
Beauregard Medical And Surgical Center, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 301 S Washington St, Deridder, LA 70634 Phone: 337-462-7409 Fax: 337-462-7479 | |
Beauregard Parish School Board Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 202 W 3rd St, Deridder, LA 70634 Phone: 337-463-5551 | |
Kufoy Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 311 S Pine St, Deridder, LA 70634 Phone: 337-463-3500 Fax: 337-463-3526 | |
Beauregard Parish School Board Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 202 W 3rd St, Deridder, LA 70634 Phone: 337-463-5551 | |
Family Health Partners Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1808 Highway 190 W, Deridder, LA 70634 Phone: 337-855-9023 Fax: 337-855-1829 |