Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 107 Lela St, Mangham, Louisiana |
Authorized Official Name and Position | Terri Lynn Klick (OWNER) |
Authorized Official Contact | 3182484100 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
107 Lela St Mangham LA 71259-5063 Ph: (318) 248-4100 | 107 Lela St Mangham LA 71259-5063 Ph: (318) 248-4100 |
NPI Number | 1023399888 |
---|---|
Provider Enumeration Date | 09/06/2011 |
Last Update Date | 10/20/2011 |
Medicare PECOS PAC ID | 8729251244 |
---|---|
Medicare Enrollment ID | O20111028000357 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023399888 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | APO6543 (Louisiana) | Primary |
Provider Name | Terri L Klick |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1558649905 PECOS PAC ID: 1254503766 Enrollment ID: I20111005000538 |
Provider Name | Jeffrey O White |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033559174 PECOS PAC ID: 9133354178 Enrollment ID: I20131030000178 |
Provider Name | Lashelle S Harris |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1952657868 PECOS PAC ID: 4688814866 Enrollment ID: I20200110002100 |
Doctors Bringing It Home Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 107 Lela St, Mangham, LA 71259 Phone: 318-303-3035 Fax: 308-248-2168 | |
Ronald J Morgan, A Professional Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 107 Lela St, Mangham, LA 71259 Phone: 318-248-2165 Fax: 318-248-2168 | |