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NPI Code Detail

MEDICARE: DAVID RAINES COMMUNITY HEALTH CENTER, INC

MEDICARE: DAVID RAINES COMMUNITY HEALTH CENTER, INC
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
1261QF0400XFederally Qualified Health Center (FQHC)LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215933254
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID RAINES COMMUNITY HEALTH CENTER, INC
Provider Business Mailing Address
First Line : 3041 DR MARTIN LUTHER KING DR
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-4705
Country : US
Telephone Number : 318-227-3350
Fax Number : 318-222-2979
Provider Business Practice Location Address
First Line : 1625 DAVID RAINES RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-5899
Country : US
Telephone Number : 318-425-2252
Fax Number : 318-716-3265
Authorized Official
Title or Position : CEO
Name : MR. WILLIE C WHITE III
Credential :
Telephone Number : 318-227-3350
Provider Enumeration Date : 06/23/2005
Last Update Date : 02/13/2024

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Practice Location Address:
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71107-5899
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1861415721 — DAVID RAINES COMMUNITY HEALTH CENTER INC
Practice Location Address:
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Practice Fax: 318-227-3356
1164430526 — MS. ROSALINE MICHELLE DARTY AP NP
Practice Location Address:
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SHREVEPORT, LA
71107-5899
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Practice Fax: 318-425-2367
1639260516 — DR. MICHAEL A HENLEY DDS
Practice Location Address:
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71107-5899
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1376630632 — DAVID RAINES COMMUNITY HEALTH CENTER
Practice Location Address:
1625 DAVID RAINES RD
SHREVEPORT, LA
71107-5899
Practice Phone: 318-425-2252
Practice Fax: 318-227-8510

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