| P. S. O. C. - Caro Clinic | |
|
2304 S Burnside Ave Ste 2 Gonzales LA 70737-4664 | |
| (225) 647-6533 | |
| (225) 644-7533 |
| Full Name | P. S. O. C. - Caro Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2304 S Burnside Ave Ste 2, Gonzales, Louisiana |
| Authorized Official Name and Position | Peter J. Monteyne (MEMBER OWNER) |
| Authorized Official Contact | 2256476533 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| P. S. O. C. - Caro Clinic Po Box 1499 Gonzales LA 70707-1499 Ph: (225) 647-6533 | P. S. O. C. - Caro Clinic 2304 S Burnside Ave Ste 2 Gonzales LA 70737-4664 Ph: (225) 647-6533 |
| NPI Number | 1467507913 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 11/27/2018 |
| Medicare PECOS PAC ID | 8022051234 |
|---|---|
| Medicare Enrollment ID | O20100628000040 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467507913 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Peter J Monteyne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043222508 PECOS PAC ID: 9537102645 Enrollment ID: I20050609000060 |
| Provider Name | Richard J Caro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467519678 PECOS PAC ID: 3476580879 Enrollment ID: I20050718000557 |
| Provider Name | Brandi Lea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437108172 PECOS PAC ID: 9436163193 Enrollment ID: I20060201000736 |
| Provider Name | Gina T Jory |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104149905 PECOS PAC ID: 0648394619 Enrollment ID: I20100826001278 |
| Provider Name | Racine Dominique Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073216719 PECOS PAC ID: 5092169474 Enrollment ID: I20231004001283 |
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