Pine Prairie Community Clinic Llc | |
1121 Walnut Street Pine Prairie LA 70576 | |
(337) 599-2800 | |
(337) 599-2210 |
Full Name | Pine Prairie Community Clinic Llc |
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Speciality | Clinic/Center |
Location | 1121 Walnut Street, Pine Prairie, Louisiana |
Authorized Official Name and Position | Carmen Nicole Rollins (CEO) |
Authorized Official Contact | 3375992800 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Pine Prairie Community Clinic Llc Po Box 542 Pine Prairie LA 70576-0542 Ph: (337) 599-2800 | Pine Prairie Community Clinic Llc 1121 Walnut Street Pine Prairie LA 70576 Ph: (337) 599-2800 |
NPI Number | 1174036388 |
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Provider Enumeration Date | 11/09/2017 |
Last Update Date | 11/05/2020 |
Medicare PECOS PAC ID | 1951668532 |
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Medicare Enrollment ID | O20171207000211 |
Identifier | Type | State | Issuer |
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1174036388 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (Louisiana) | Secondary |
261QR1300X | Clinic/center - Rural Health | 2203783773 (Louisiana) | Primary |
Pine Prairie Family Healthcare, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1015 Sanders Street, Pine Prairie, LA 70576 Phone: 337-599-2850 Fax: 337-599-2852 |