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General NPI Number Information
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NPI Number | 1891309506
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Entity Type | Organization
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Legal Business Name | LHCG CLXIX, LLC
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 828 CRESWELL LN
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City | OPELOUSAS
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State | LA
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Zip | 70570-5882
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Country | US
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Telephone | 337-948-1802
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51266
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City | LAFAYETTE
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State | LA
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Zip | 70505-1266
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Country | US
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Telephone | 337-233-1307
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Fax | 337-233-5764
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Authorized Official
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Title or Position | CEO
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Name | DAVID WAYNE INGRAM
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Credential |
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Telephone | 337-363-9486
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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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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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