Healthcare Provider Details

I. General information

NPI: 1134136708
Provider Name (Legal Business Name): CHADHA MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W 4TH ST
DEQUINCY LA
70633-3508
US

IV. Provider business mailing address

140 W 4TH ST
DEQUINCY LA
70633-3508
US

V. Phone/Fax

Practice location:
  • Phone: 337-786-5007
  • Fax: 337-786-5009
Mailing address:
  • Phone: 337-786-5007
  • Fax: 337-786-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number27211
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number27211
License Number StateLA

VIII. Authorized Official

Name: MR. JAGJIT CHADHA
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 337-786-5007