| |
18333 Highway 182 Rm 505 Baldwin LA 70514-1449 | |
(337) 924-9418 | |
(337) 924-9165 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 18333 Highway 182 Rm 505, Baldwin, 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 |
---|---|
1115 Weber St Franklin LA 70538-4124 Ph: (337) 828-2550 | 18333 Highway 182 Rm 505 Baldwin LA 70514-1449 Ph: (337) 924-9418 |
NPI Number | 1902082811 |
---|---|
Provider Enumeration Date | 01/10/2008 |
Last Update Date | 02/04/2025 |
Medicare PECOS PAC ID | 0648163980 |
---|---|
Medicare Enrollment ID | O20091230000218 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902082811 | NPI | - | NPPES |
1908347 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Louisiana) | Primary |