| Life Coast Community Health Center Inc | |
|
1101 Audubon Ave Ste S1 Thibodaux LA 70301-4957 | |
| (985) 492-6170 | |
| (985) 492-6177 |
| Full Name | Life Coast Community Health Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1101 Audubon Ave Ste S1, Thibodaux, Louisiana |
| Authorized Official Name and Position | Diane Webre (CLINIC MANAGER) |
| Authorized Official Contact | 9854926170 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Coast Community Health Center Inc 1101 Audubon Ave Ste S1 Thibodaux LA 70301-4957 Ph: (985) 492-6170 | Life Coast Community Health Center Inc 1101 Audubon Ave Ste S1 Thibodaux LA 70301-4957 Ph: (985) 492-6170 |
| NPI Number | 1962113084 |
|---|---|
| Provider Enumeration Date | 12/09/2022 |
| Last Update Date | 12/09/2022 |
| Medicare PECOS PAC ID | 3870929193 |
|---|---|
| Medicare Enrollment ID | O20221219002002 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962113084 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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Life Coast Community Health Center Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1101 Audubon Ave Ste S1, Thibodaux, LA 70301 Phone: 985-492-6170 | |
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