Willow Chute Medical, Llc | |
4910 Airline Dr Bossier City LA 71111-6607 | |
(318) 349-3921 | |
Not Available |
Full Name | Willow Chute Medical, Llc |
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Speciality | Family Medicine |
Location | 4910 Airline Dr, Bossier City, Louisiana |
Authorized Official Name and Position | Clint N. Wilson (OWNER) |
Authorized Official Contact | 3183493921 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Willow Chute Medical, Llc 732 Smokehouse Loop Benton LA 71006-8000 Ph: (318) 349-3921 | Willow Chute Medical, Llc 4910 Airline Dr Bossier City LA 71111-6607 Ph: (318) 349-3921 |
NPI Number | 1033987151 |
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Provider Enumeration Date | 12/18/2023 |
Last Update Date | 12/20/2023 |
Medicare PECOS PAC ID | 1254784721 |
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Medicare Enrollment ID | O20240131003565 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033987151 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Clint N Wilson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1427269059 PECOS PAC ID: 8820142680 Enrollment ID: I20090813000736 |
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Abaka Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4438 Viking Dr, Bossier City, LA 71111 Phone: 318-918-0015 Fax: 318-963-0015 | |
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Injurymd Of Bossier, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5015 Shed Rd Ste 500, Bossier City, LA 71111 Phone: 318-741-5858 Fax: 318-741-4496 |