Mandeville Private Physician Group | |
141 Lakeview Cir Covington LA 70433-7513 | |
(985) 630-9618 | |
(985) 231-7010 |
Full Name | Mandeville Private Physician Group |
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Speciality | Family Medicine |
Location | 141 Lakeview Cir, Covington, Louisiana |
Authorized Official Name and Position | Richard Michael Jeansonne (PHYSICIAN) |
Authorized Official Contact | 9856309618 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mandeville Private Physician Group Po Box 335 Mandeville LA 70470-0335 Ph: (985) 630-9618 | Mandeville Private Physician Group 141 Lakeview Cir Covington LA 70433-7513 Ph: (985) 630-9618 |
NPI Number | 1437553617 |
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Provider Enumeration Date | 10/16/2014 |
Last Update Date | 05/01/2017 |
Medicare PECOS PAC ID | 9931422284 |
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Medicare Enrollment ID | O20141218000357 |
Identifier | Type | State | Issuer |
---|---|---|---|
1437553617 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 025708 (Louisiana) | Primary |
Provider Name | Richard M Jeansonne |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1467468447 PECOS PAC ID: 5698744241 Enrollment ID: I20090820000415 |
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