Full Name | |
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Speciality | Clinic/Center |
Location | 710 5th St, Gueydan, Louisiana |
Authorized Official Name and Position | Denise V Trahan (INTERIM VP OF COMPLIANCE) |
Authorized Official Contact | 3372898292 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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920 W Pinhook Rd Lafayette LA 70503-2455 Ph: (337) 289-8292 | 710 5th St Gueydan LA 70542-3612 Ph: (337) 536-9262 |
NPI Number | 1235752775 |
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Provider Enumeration Date | 05/19/2020 |
Last Update Date | 03/22/2024 |
Medicare PECOS PAC ID | 5799099164 |
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Medicare Enrollment ID | O20211027002128 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235752775 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |