Full Name | |
---|---|
Speciality | Family Medicine |
Location | 815 S Pine St, Vivian, Louisiana |
Authorized Official Name and Position | Dakota Robinson (CFO) |
Authorized Official Contact | 3183754097 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
815 S Pine St Vivian LA 71082-3353 Ph: (318) 375-4007 | 815 S Pine St Vivian LA 71082-3353 Ph: (318) 375-4007 |
NPI Number | 1003310756 |
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Provider Enumeration Date | 03/19/2018 |
Last Update Date | 05/13/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003310756 | NPI | - | NPPES |
1038130 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Medical & Surgical Clinic A Medical Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1003 South Spruce St, Vivian, LA 71082 Phone: 318-375-3239 Fax: 318-375-2755 |