Healthcare Provider Details

I. General information

NPI: 1528046513
Provider Name (Legal Business Name): CLECO PRIMARY CARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 SCHENCK STREET
SHELBY NC
28150
US

IV. Provider business mailing address

808 SCHENCK STREET
SHELBY NC
28150-3934
US

V. Phone/Fax

Practice location:
  • Phone: 704-480-9344
  • Fax: 704-484-3260
Mailing address:
  • Phone: 704-480-9344
  • Fax: 704-484-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BETTY H SHUBERT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-484-1889