MEDICARE: CLECO PRIMARY CARE NETWORK

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
1	207Q00000X	Family Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1295715647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLECO PRIMARY CARE NETWORK

Provider Business Mailing Address
First Line	:	101 GROVER ST
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150
Country	:	US
Telephone Number	:	704-484-3647
Fax Number	:	704-471-2727

Provider Business Practice Location Address
First Line	:	600 W CHURCH ST
Second Line	:
City	:	CHERRYVILLE
State	:	NC
Zip	:	28021-2863
Country	:	US
Telephone Number	:	704-435-4111
Fax Number	:	704-435-4113

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DENISE ROLLINS COOPER
Credential	:
Telephone Number	:	704-484-3647

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	08/31/2007

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Directions to “CLECO PRIMARY CARE NETWORK ” Practice Location

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