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NPI Code Detail

MEDICARE: DAVID RAINES COMMUNITY HEALTH CENTER INC

MEDICARE: DAVID RAINES COMMUNITY HEALTH CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0002XClinic Pharmacy
23336M0003XManaged Care Organization Pharmacy
3333600000XPharmacy
43336C0003XCommunity/Retail PharmacyPHY.005457-IRLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22035347OTHERPK

General Provider Information

NPI Number : 1861415721
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID RAINES COMMUNITY HEALTH CENTER INC
Provider Business Mailing Address
First Line : 1625 DAVID RAINES RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-5899
Country : US
Telephone Number : 318-227-3355
Fax Number : 318-227-3356
Provider Business Practice Location Address
First Line : 1625 DAVID RAINES RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-5899
Country : US
Telephone Number : 318-227-3355
Fax Number : 318-227-3356
Authorized Official
Title or Position : CEO
Name : WILLIE WHITE
Credential :
Telephone Number : 318-227-3342
Provider Enumeration Date : 07/25/2006
Last Update Date : 12/22/2016

Similar Medicare Providers

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Practice Location Address:
1625 DAVID RAINES RD
SHREVEPORT, LA
71107-5899
Practice Phone: 318-425-2252
Practice Fax: 318-716-3265
1275508962 — LAWRENCE DWAYNE COUNTS MD
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Practice Fax: 318-425-2367
1285650713 — GEORGE C HENDERSON JR. M.D.
Practice Location Address:
1625 DAVID RAINES RD
SHREVEPORT, LA
71107-5899
Practice Phone: 318-841-6048
Practice Fax: 318-841-6044
1164430526 — MS. ROSALINE MICHELLE DARTY AP NP
Practice Location Address:
1625 DAVID RAINES RD
SHREVEPORT, LA
71107-5899
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Practice Fax: 318-425-2367
1639260516 — DR. MICHAEL A HENLEY DDS
Practice Location Address:
1625 DAVID RAINES RD
SHREVEPORT, LA
71107-5899
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Practice Fax: 318-227-3357
1376630632 — DAVID RAINES COMMUNITY HEALTH CENTER
Practice Location Address:
1625 DAVID RAINES RD
SHREVEPORT, LA
71107-5899
Practice Phone: 318-425-2252
Practice Fax: 318-227-8510

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