Lady Of The Sea Medical Clinic - Larose | |
13030 Highway 308 Larose LA 70345-4143 | |
(985) 798-7000 | |
(985) 798-7021 |
Full Name | Lady Of The Sea Medical Clinic - Larose |
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Speciality | Clinic/Center |
Location | 13030 Highway 308, Larose, Louisiana |
Authorized Official Name and Position | Tad A Lafont (CHIEF CLINIC OFFCIER) |
Authorized Official Contact | 9856326401 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lady Of The Sea Medical Clinic - Larose 13030 Highway 308 Larose LA 70373-2056 Ph: (985) 798-7000 | Lady Of The Sea Medical Clinic - Larose 13030 Highway 308 Larose LA 70345-4143 Ph: (985) 798-7000 |
NPI Number | 1932256542 |
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Provider Enumeration Date | 01/04/2007 |
Last Update Date | 03/24/2023 |
Medicare PECOS PAC ID | 2264342229 |
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Medicare Enrollment ID | O20040331000277 |
Identifier | Type | State | Issuer |
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1932256542 | NPI | - | NPPES |
1457671 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Camille C Pitre |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1073568341 PECOS PAC ID: 7113996075 Enrollment ID: I20040928000293 |
Provider Name | Lenny A Folse |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1801836135 PECOS PAC ID: 6507871472 Enrollment ID: I20060214000290 |
Provider Name | Duane J Luke |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1164429544 PECOS PAC ID: 1355436361 Enrollment ID: I20071005000571 |
Provider Name | John G Jackson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1063497683 PECOS PAC ID: 7719950096 Enrollment ID: I20080227000214 |
Provider Name | Rachelle R Guidry |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679028260 PECOS PAC ID: 5496022766 Enrollment ID: I20170517002323 |
Provider Name | Amanda Olivier Rogers |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1073977054 PECOS PAC ID: 1355649682 Enrollment ID: I20190808002020 |
Jay Vega Md.,a.p.m.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 13030 Highway 308, Larose, LA 70373 Phone: 985-798-5611 Fax: 985-798-5648 |