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120 N Carolina St New Roads LA 70760-3604 | |
| (225) 713-4044 | |
| (225) 208-1188 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 N Carolina St, New Roads, 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 |
|---|---|
302 Hacker St New Iberia LA 70560-4508 Ph: (337) 330-2576 | 120 N Carolina St New Roads LA 70760-3604 Ph: (225) 713-4044 |
| NPI Number | 1477027894 |
|---|---|
| Provider Enumeration Date | 01/18/2019 |
| Last Update Date | 12/03/2024 |
| Medicare PECOS PAC ID | 2466476023 |
|---|---|
| Medicare Enrollment ID | O20190301001081 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477027894 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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