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General NPI Number Information
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NPI Number | 1780875740
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Entity Type | Organization
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Legal Business Name | CHACHERE PROVOST MEDICINE, LLC
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 3975 I 49 S SERVICE RD SUITE 205A
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City | OPELOUSAS
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State | LA
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Zip | 70570-0775
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Country | US
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Telephone | 337-942-2323
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Fax | 337-942-2626
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Provider Business Mailing Address
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Address Line | 3975 I 49 S SERVICE RD SUITE 205A
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City | OPELOUSAS
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State | LA
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Zip | 70570-0775
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Country | US
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Telephone | 337-942-2323
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Fax | 337-942-2626
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Authorized Official
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Title or Position | OWNER
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Name | DR. HOLLY C. PROVOST
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Credential | M.D.
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Telephone | 337-942-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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