Healthcare Provider Details

I. General information

NPI: 1033700539
Provider Name (Legal Business Name): CLHG-LEESVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S ARKANSAS STREET
LEESVILLE LA
71446
US

IV. Provider business mailing address

1020 W FERTITTA BLVD
LEESVILLE LA
71446-4645
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-7227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRITTANEY L HIPPLER
Title or Position: REGIONAL DIRECTOR OF CLINIC OPERATI
Credential:
Phone: 318-315-7093