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104 Verona Street Newellton LA 71357 | |
(318) 467-9949 | |
(318) 467-2093 |
Full Name | |
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Speciality | Clinic/Center |
Location | 104 Verona Street, Newellton, Louisiana |
Authorized Official Name and Position | Michael Blake Kramer (ADMINISTRATOR) |
Authorized Official Contact | 3184125265 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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104 Verona Street Newellton LA 71357 Ph: (318) 467-9949 | 104 Verona Street Newellton LA 71357 Ph: (318) 467-9949 |
NPI Number | 1831144054 |
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Provider Enumeration Date | 05/24/2006 |
Last Update Date | 11/05/2018 |
Medicare PECOS PAC ID | 7810893302 |
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Medicare Enrollment ID | O20070706000515 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831144054 | NPI | - | NPPES |
1440990 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 181RHC-1 (Louisiana) | Primary |