| |
310 West Mississippi Ave. Ruston LA 71270-9541 | |
(318) 513-1212 | |
(318) 513-7673 |
Full Name | |
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Speciality | Family Medicine |
Location | 310 West Mississippi Ave., Ruston, Louisiana |
Authorized Official Name and Position | Jackie K White (MEDICAL DIRECTOR) |
Authorized Official Contact | 3185131212 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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310 West Mississippi Ave. Ruston LA 71270-9541 Ph: (318) 513-1212 | 310 West Mississippi Ave. Ruston LA 71270-9541 Ph: (318) 513-1212 |
NPI Number | 1649564824 |
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Provider Enumeration Date | 06/05/2011 |
Last Update Date | 03/31/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649564824 | NPI | - | NPPES |
2428438 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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