| |
1124 7th St Morgan City LA 70380-1951 | |
(985) 384-2371 | |
(985) 384-2645 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1124 7th St, Morgan City, Louisiana |
Authorized Official Name and Position | Gary M Wiltz (CEO) |
Authorized Official Contact | 3378282550 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1115 Weber St Franklin LA 70538-4124 Ph: (337) 828-2550 | 1124 7th St Morgan City LA 70380-1951 Ph: (985) 384-2371 |
NPI Number | 1124307566 |
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Provider Enumeration Date | 08/16/2011 |
Last Update Date | 07/12/2023 |
Medicare PECOS PAC ID | 0648163980 |
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Medicare Enrollment ID | O20120127000498 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124307566 | NPI | - | NPPES |
5B803 | Other | LA | MEDICARE PART B |
2195417 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Louisiana) | Primary |
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