| |
1643 Carter St Vidalia LA 71373-3156 | |
(318) 336-8707 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1643 Carter St, Vidalia, Louisiana |
Authorized Official Name and Position | Nekeisha Lashay Smith (ADMINISTRATOR) |
Authorized Official Contact | 3187193636 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 111 Ferriday LA 71334-0111 Ph: () - | 1643 Carter St Vidalia LA 71373-3156 Ph: (318) 336-8707 |
NPI Number | 1780190322 |
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Provider Enumeration Date | 12/19/2017 |
Last Update Date | 10/05/2022 |
Medicare PECOS PAC ID | 4587559935 |
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Medicare Enrollment ID | O20171213002360 |
Identifier | Type | State | Issuer |
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1780190322 | NPI | - | NPPES |
2481011 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (Louisiana) | Primary |
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