| Providence Primary Care, Llc | |
|
1000 Chinaberry Dr Ste 1002 Bossier City LA 71111-2463 | |
| (318) 562-3911 | |
| (318) 656-3761 |
| Full Name | Providence Primary Care, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1000 Chinaberry Dr Ste 1002, Bossier City, Louisiana |
| Authorized Official Name and Position | Lindsey Marlowe Rodgers (OWNER) |
| Authorized Official Contact | 3185623911 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Primary Care, Llc 1233 Big Pine Key Ln Benton LA 71006-8728 Ph: (318) 458-4526 | Providence Primary Care, Llc 1000 Chinaberry Dr Ste 1002 Bossier City LA 71111-2463 Ph: (318) 562-3911 |
| NPI Number | 1386238525 |
|---|---|
| Provider Enumeration Date | 02/28/2021 |
| Last Update Date | 10/23/2024 |
| Medicare PECOS PAC ID | 1850790023 |
|---|---|
| Medicare Enrollment ID | O20210520002973 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386238525 | NPI | - | NPPES |
| Provider Name | Lindsey Marlowe Fortenberry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740573047 PECOS PAC ID: 4981870706 Enrollment ID: I20150224000629 |
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