Healthcare Provider Details

I. General information

NPI: 1750400586
Provider Name (Legal Business Name): CHRISTUS HEALTH CENTRAL LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17763 HIGHWAY 167
DRY PRONG LA
71423-9205
US

IV. Provider business mailing address

3330 MASONIC DR
ALEXANDRIA LA
71301-3841
US

V. Phone/Fax

Practice location:
  • Phone: 318-899-5276
  • Fax: 318-899-5932
Mailing address:
  • Phone: 318-483-4031
  • Fax: 318-483-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number234
License Number StateLA

VIII. Authorized Official

Name: MONTE WILSON
Title or Position: CEO
Credential:
Phone: 337-470-2100