Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 15712 Hwy 165, Urania, Louisiana |
Authorized Official Name and Position | Paul Mathews (ADMINISTRATOR) |
Authorized Official Contact | 3184953131 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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15712 Hwy 165 Olla LA 71465 Ph: (318) 495-3131 | 15712 Hwy 165 Urania LA 71480 Ph: (318) 495-3131 |
NPI Number | 1821401241 |
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Provider Enumeration Date | 06/03/2014 |
Last Update Date | 01/18/2024 |
Medicare PECOS PAC ID | 6709781545 |
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Medicare Enrollment ID | O20141008000965 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821401241 | NPI | - | NPPES |
2384716 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Manish Dhawan |
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Provider Type | Practitioner - Hematology/oncology |
Provider Identifiers | NPI Number: 1083618912 PECOS PAC ID: 8820159197 Enrollment ID: I20100106000235 |