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12713 Water Way Maurepas LA 70449-1200 | |
(225) 698-0211 | |
(225) 424-6009 |
Full Name | |
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Speciality | Clinic/Center |
Location | 12713 Water Way, Maurepas, Louisiana |
Authorized Official Name and Position | Antoinette Rabenaldt (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 3373302576 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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302 Hacker St New Iberia LA 70560-4508 Ph: (337) 330-2576 | 12713 Water Way Maurepas LA 70449-1200 Ph: (225) 698-0211 |
NPI Number | 1588138903 |
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Provider Enumeration Date | 01/18/2019 |
Last Update Date | 12/03/2024 |
Medicare PECOS PAC ID | 2466476023 |
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Medicare Enrollment ID | O20190222001392 |
Identifier | Type | State | Issuer |
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1588138903 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |