Healthcare Provider Details

I. General information

NPI: 1295715647
Provider Name (Legal Business Name): CLECO PRIMARY CARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W CHURCH ST
CHERRYVILLE NC
28021-2863
US

IV. Provider business mailing address

101 GROVER ST
SHELBY NC
28150
US

V. Phone/Fax

Practice location:
  • Phone: 704-435-4111
  • Fax: 704-435-4113
Mailing address:
  • Phone: 704-484-3647
  • Fax: 704-471-2727

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: DENISE ROLLINS COOPER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-484-3647