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1020 Main St Hackberry LA 70645-3303 | |
(337) 762-3762 | |
(337) 762-3838 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1020 Main St, Hackberry, Louisiana |
Authorized Official Name and Position | Janie Fruge (CEO) |
Authorized Official Contact | 3375274241 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1020 Main St Hackberry LA 70645-3303 Ph: (337) 762-3762 | 1020 Main St Hackberry LA 70645-3303 Ph: (337) 762-3762 |
NPI Number | 1467456814 |
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Provider Enumeration Date | 06/13/2005 |
Last Update Date | 09/30/2016 |
Medicare PECOS PAC ID | 1052221447 |
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Medicare Enrollment ID | O20041013001232 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467456814 | NPI | - | NPPES |
1945251 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 001 (Louisiana) | Primary |