| Wk Palmetto Family Practice | |
|
1001 Lackland Blvd Ste 120 Benton LA 71006-2505 | |
| (318) 935-1522 | |
| (318) 935-1525 |
| Full Name | Wk Palmetto Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 1001 Lackland Blvd Ste 120, Benton, Louisiana |
| Authorized Official Name and Position | Mary Jane Ward (SENIOR VP FINANCE) |
| Authorized Official Contact | 3182128299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wk Palmetto Family Practice 1001 Lackland Blvd Ste 120 Benton LA 71006-2505 Ph: (318) 935-1522 | Wk Palmetto Family Practice 1001 Lackland Blvd Ste 120 Benton LA 71006-2505 Ph: (318) 935-1522 |
| NPI Number | 1588270581 |
|---|---|
| Provider Enumeration Date | 09/16/2020 |
| Last Update Date | 08/12/2021 |
| Medicare PECOS PAC ID | 6608296157 |
|---|---|
| Medicare Enrollment ID | O20201021003059 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588270581 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lindsey Tassin Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740642164 PECOS PAC ID: 3779877915 Enrollment ID: I20190806001907 |
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