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NPI Code Detail

MEDICARE: DREW OUTPATIENT CLINIC, LLC

MEDICARE: DREW OUTPATIENT CLINIC, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center018471LA

General Provider Information

NPI Number : 1003960535
Entity Type Code : Organization
Provider Name (Legal Business Name) : DREW OUTPATIENT CLINIC, LLC
Provider Business Mailing Address
First Line : 1117 CHENIERE DREW RD
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-8551
Country : US
Telephone Number : 318-329-4370
Fax Number : 318-329-4356
Provider Business Practice Location Address
First Line : 1117 CHENIERE DREW RD
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-8551
Country : US
Telephone Number : 318-329-4370
Fax Number : 318-329-4356
Authorized Official
Title or Position : OFFICE MANAGER,CO-OWNER
Name : MRS. TERRY N. EPPINETTE
Credential : R.N.
Telephone Number : 318-329-4370
Provider Enumeration Date : 01/22/2007
Last Update Date : 08/22/2020

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