Healthcare Provider Details

I. General information

NPI: 1154012185
Provider Name (Legal Business Name): CLHG-RUSTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CELEBRITY DR
RUSTON LA
71270-3893
US

IV. Provider business mailing address

1200 CELEBRITY DR
RUSTON LA
71270-3893
US

V. Phone/Fax

Practice location:
  • Phone: 318-254-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY M HALL
Title or Position: CEO
Credential:
Phone: 318-254-2450