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307 Chisum St Sicily Island LA 71368-4807 | |
(318) 389-5727 | |
(318) 389-4028 |
Full Name | |
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Speciality | Family Medicine |
Location | 307 Chisum St, Sicily Island, Louisiana |
Authorized Official Name and Position | Debra K Miesch (CEO) |
Authorized Official Contact | 3183895727 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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302 Bushley St Harrisonburg LA 71340-1656 Ph: (318) 389-5727 | 307 Chisum St Sicily Island LA 71368-4807 Ph: (318) 389-5727 |
NPI Number | 1821459835 |
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Provider Enumeration Date | 03/18/2016 |
Last Update Date | 05/09/2022 |
Medicare PECOS PAC ID | 8729067434 |
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Medicare Enrollment ID | O20170915002716 |
Identifier | Type | State | Issuer |
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1821459835 | NPI | - | NPPES |
1903191 | Medicaid | LA | |
10464 | Other | LA | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 018530 (Louisiana) | Primary |
Catahoula Parish Hospital District No 2 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 710 Chisum Street, Sicily Island, LA 71368 Phone: 318-389-5727 Fax: 318-389-9943 | |