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317 Dernier Street St. Martinville LA 70582 | |
(337) 365-4945 | |
(337) 367-3917 |
Full Name | |
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Speciality | Clinic/Center |
Location | 317 Dernier Street, St. Martinville, Louisiana |
Authorized Official Name and Position | Roderick Campbell (CEO) |
Authorized Official Contact | 3373654945 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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317 Dernier Street St. Martinville LA 70582 Ph: () - | 317 Dernier Street St. Martinville LA 70582 Ph: (337) 365-4945 |
NPI Number | 1821286899 |
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Provider Enumeration Date | 10/04/2007 |
Last Update Date | 12/01/2021 |
Medicare PECOS PAC ID | 6204817828 |
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Medicare Enrollment ID | O20071217000453 |
Identifier | Type | State | Issuer |
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1821286899 | NPI | - | NPPES |
1028088 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |