| Headache And Wellness Center Of Southwest Louisiana, Llc | |
|
803 W Bayou Pines Dr Ste B Lake Charles LA 70601-7096 | |
| (337) 508-2333 | |
| Not Available |
| Full Name | Headache And Wellness Center Of Southwest Louisiana, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 803 W Bayou Pines Dr Ste B, Lake Charles, Louisiana |
| Authorized Official Name and Position | Darci L Portie (OWNER) |
| Authorized Official Contact | 3375082333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Headache And Wellness Center Of Southwest Louisiana, Llc 803 W Bayou Pines Dr Ste B Lake Charles LA 70601-7096 Ph: (337) 508-2333 | Headache And Wellness Center Of Southwest Louisiana, Llc 803 W Bayou Pines Dr Ste B Lake Charles LA 70601-7096 Ph: (337) 508-2333 |
| NPI Number | 1043814486 |
|---|---|
| Provider Enumeration Date | 11/25/2020 |
| Last Update Date | 09/01/2021 |
| Medicare PECOS PAC ID | 9931514494 |
|---|---|
| Medicare Enrollment ID | O20210215000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043814486 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Darci Landry Portie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033592886 PECOS PAC ID: 0244547305 Enrollment ID: I20150922002162 |
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