| Louisiana Family Medicine Clinic 1 | |
|
103 Watts St Jonesboro LA 71251-2053 | |
| (318) 259-1569 | |
| (318) 259-8523 |
| Full Name | Louisiana Family Medicine Clinic 1 |
|---|---|
| Speciality | Clinic/Center |
| Location | 103 Watts St, Jonesboro, Louisiana |
| Authorized Official Name and Position | Dirk Timothy Rainwater (CEO) |
| Authorized Official Contact | 3185603486 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Louisiana Family Medicine Clinic 1 103 Watts St Jonesboro LA 71251-2053 Ph: (318) 259-1569 | Louisiana Family Medicine Clinic 1 103 Watts St Jonesboro LA 71251-2053 Ph: (318) 259-1569 |
| NPI Number | 1548538200 |
|---|---|
| Provider Enumeration Date | 12/09/2011 |
| Last Update Date | 06/18/2015 |
| Medicare PECOS PAC ID | 4183889009 |
|---|---|
| Medicare Enrollment ID | O20120627000379 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548538200 | NPI | - | NPPES |
| 2344188 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 025000 (Louisiana) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | 025000 (Louisiana) | Secondary |
| Provider Name | Dirk T Rainwater |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043286230 PECOS PAC ID: 0143133751 Enrollment ID: I20031110000610 |
| Provider Name | Stacy D Conville |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497702880 PECOS PAC ID: 9537186069 Enrollment ID: I20051025000079 |
| Provider Name | George T Waterfallen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831123132 PECOS PAC ID: 4587668744 Enrollment ID: I20060831000352 |
| Provider Name | Jessica L Carter Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801082920 PECOS PAC ID: 2264520444 Enrollment ID: I20071126000110 |
| Provider Name | Mark A Portacci |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265500490 PECOS PAC ID: 5193887156 Enrollment ID: I20081229000508 |
| Provider Name | Jamie M Portacci |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659503092 PECOS PAC ID: 0941349625 Enrollment ID: I20091209000691 |
| Provider Name | Alison Creel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720528680 PECOS PAC ID: 2466738422 Enrollment ID: I20170406001028 |
| Provider Name | Gelinia Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518479948 PECOS PAC ID: 9739423724 Enrollment ID: I20181203000171 |
| Provider Name | James D Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073022042 PECOS PAC ID: 7416215835 Enrollment ID: I20181203000305 |
| Provider Name | Derek T Rainwater |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1548767437 PECOS PAC ID: 0244584662 Enrollment ID: I20201210000224 |
| Provider Name | Andrew Aaron Gong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568950160 PECOS PAC ID: 1456737758 Enrollment ID: I20230410001674 |
Mercy Medical Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 244 Bond St, Jonesboro, LA 71251 Phone: 318-259-1100 Fax: 318-259-1333 | |
Jackson Parish Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 165 Beech Springs Rd, Jonesboro, LA 71251 Phone: 318-259-4435 Fax: 318-395-4291 | |
Jackson Parish School Board Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 Northeast St, Jonesboro, LA 71251 Phone: 318-259-8802 | |
Jackson Parish Hospital School Based Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 225 Pershing Hwy, Jonesboro, LA 71251 Phone: 318-395-0049 Fax: 318-395-0061 | |
Just Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 E Court St Rm 201, Jonesboro, LA 71251 Phone: 833-784-2669 Fax: 844-784-2329 | |
Just Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 E Court St Rm 100, Jonesboro, LA 71251 Phone: 318-259-9021 | |
Health Express Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 510 Alexander St, Jonesboro, LA 71251 Phone: 318-259-2148 |