| Poche' Medical Clinic | |
|
1645 Lutcher Ave Lutcher LA 70071-5150 | |
| (225) 869-3493 | |
| (225) 869-9333 |
| Full Name | Poche' Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1645 Lutcher Ave, Lutcher, Louisiana |
| Authorized Official Name and Position | Mary Ellen G Pratt (CEO) |
| Authorized Official Contact | 2252585990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Poche' Medical Clinic 1645 Lutcher Ave Lutcher LA 70071-5150 Ph: (225) 258-5906 | Poche' Medical Clinic 1645 Lutcher Ave Lutcher LA 70071-5150 Ph: (225) 869-3493 |
| NPI Number | 1649617689 |
|---|---|
| Provider Enumeration Date | 05/31/2013 |
| Last Update Date | 05/08/2017 |
| Medicare PECOS PAC ID | 3476459850 |
|---|---|
| Medicare Enrollment ID | O20130827000322 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649617689 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Randall Poche |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730255696 PECOS PAC ID: 8527111723 Enrollment ID: I20100816000284 |
| Provider Name | Jerry M Poche |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255407110 PECOS PAC ID: 7618020819 Enrollment ID: I20101005000747 |
| Provider Name | Denise S Louque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265893739 PECOS PAC ID: 3072812981 Enrollment ID: I20160427001975 |
| Provider Name | Dylan Edward Poche |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093219867 PECOS PAC ID: 6507277514 Enrollment ID: I20201124000806 |
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Poche Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2454 Louisiana Ave, Lutcher, LA 70071 Phone: 225-860-3493 Fax: 225-869-9333 |