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121 West 134th Place Galliano LA 70354 | |
(337) 828-2550 | |
(337) 355-2335 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 121 West 134th Place, Galliano, Louisiana |
Authorized Official Name and Position | Gary Wiltz (CEO) |
Authorized Official Contact | 3378282550 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1115 Weber St Franklin LA 70538-4124 Ph: (337) 828-2550 | 121 West 134th Place Galliano LA 70354 Ph: (337) 828-2550 |
NPI Number | 1215354014 |
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Provider Enumeration Date | 03/19/2014 |
Last Update Date | 07/20/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215354014 | NPI | - | NPPES |
2381849 | Medicaid | LA | |
5B803 | Other | LA | MEDICARE PART B |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Louisiana) | Primary |