=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487548301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTUS HEALTH CENTRAL LOUISIANA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2025
-----------------------------------------------------
Last Update Date | 06/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4974 HIGHWAY 3276 STE B
-----------------------------------------------------
City | STONEWALL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71078-9306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-932-2199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1635 MARVEL ST
-----------------------------------------------------
City | COUSHATTA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71019-9022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MONTE WILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-470-2100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------