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General NPI Number Information
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NPI Number | 1295715647
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Entity Type | Organization
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Legal Business Name | CLECO PRIMARY CARE NETWORK
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 600 W CHURCH ST
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City | CHERRYVILLE
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State | NC
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Zip | 28021-2863
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Country | US
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Telephone | 704-435-4111
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Fax | 704-435-4113
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Provider Business Mailing Address
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Address Line | 101 GROVER ST
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City | SHELBY
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State | NC
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Zip | 28150
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Country | US
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Telephone | 704-484-3647
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Fax | 704-471-2727
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DENISE ROLLINS COOPER
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Credential |
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Telephone | 704-484-3647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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