South Louisiana Primary Care Llc | |
12902 Plank Rd Baker LA 70714-4911 | |
(225) 218-4816 | |
(225) 302-5057 |
Full Name | South Louisiana Primary Care Llc |
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Speciality | Family Medicine |
Location | 12902 Plank Rd, Baker, Louisiana |
Authorized Official Name and Position | Dustin Allen Logue (OWNER) |
Authorized Official Contact | 2257740733 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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South Louisiana Primary Care Llc 12902 Plank Rd Baker LA 70714-4911 Ph: (225) 774-0733 | South Louisiana Primary Care Llc 12902 Plank Rd Baker LA 70714-4911 Ph: (225) 218-4816 |
NPI Number | 1447705074 |
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Provider Enumeration Date | 08/24/2016 |
Last Update Date | 07/08/2024 |
Medicare PECOS PAC ID | 7416245923 |
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Medicare Enrollment ID | O20161017002159 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447705074 | NPI | - | NPPES |
2110691 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
261QP2300X | Clinic/center - Primary Care | AP06078 (Louisiana) | Secondary |
Provider Name | Ernest G Thompson |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1841212610 PECOS PAC ID: 3072692649 Enrollment ID: I20080507000424 |
Provider Name | Dustin Logue |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1003146226 PECOS PAC ID: 2769513423 Enrollment ID: I20100624000938 |
Provider Name | Hailey Mcmanus Murphy |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508414855 PECOS PAC ID: 7911372834 Enrollment ID: I20230406002285 |
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