George Keshelava, Md Llc | |
1970 N Highway 190 Covington LA 70433-5158 | |
(985) 867-8585 | |
(985) 867-3644 |
Full Name | George Keshelava, Md Llc |
---|---|
Speciality | Internal Medicine |
Location | 1970 N Highway 190, Covington, Louisiana |
Authorized Official Name and Position | George Keshelava (MD) |
Authorized Official Contact | 9858678585 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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George Keshelava, Md Llc Po Box 1870 Covington LA 70434-1870 Ph: (985) 867-8585 | George Keshelava, Md Llc 1970 N Highway 190 Covington LA 70433-5158 Ph: (985) 867-8585 |
NPI Number | 1932528486 |
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Provider Enumeration Date | 04/14/2014 |
Last Update Date | 08/03/2015 |
Medicare PECOS PAC ID | 0143442822 |
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Medicare Enrollment ID | O20141113000399 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932528486 | NPI | - | NPPES |
DV1138 | Other | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RI0200X | Internal Medicine - Infectious Disease | MD201497 (Louisiana) | Primary |
Provider Name | Stephen G Mixon |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1386610608 PECOS PAC ID: 5496710667 Enrollment ID: I20041130000207 |
Provider Name | Donna Jill Branton |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1700065570 PECOS PAC ID: 4880618040 Enrollment ID: I20060116000275 |
Provider Name | Ruby S Miller |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1710024179 PECOS PAC ID: 3779688635 Enrollment ID: I20070420000489 |
Provider Name | George T Keshelava |
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Provider Type | Practitioner - Infectious Disease |
Provider Identifiers | NPI Number: 1255541975 PECOS PAC ID: 6507957222 Enrollment ID: I20070810000015 |
Provider Name | Brianne G Lagasse |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114316635 PECOS PAC ID: 3577880384 Enrollment ID: I20150316000985 |
Provider Name | Erin Elizabeth Gill |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1346792660 PECOS PAC ID: 1254612898 Enrollment ID: I20170306002504 |
Provider Name | Michelle J Howell |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1689100786 PECOS PAC ID: 9638447709 Enrollment ID: I20170613002109 |
Provider Name | Candice Wild |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730731043 PECOS PAC ID: 0941530661 Enrollment ID: I20190924000291 |
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