MEDICARE: MEDAMERICA 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
1	261QC1500X	Community Health Clinic/Center	1416142	LA

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	:	1407901978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDAMERICA LLC

Provider Business Mailing Address
First Line	:	9305 MAIN ST
Second Line	:	SUITE D
City	:	ZACHARY
State	:	LA
Zip	:	70791-7441
Country	:	US
Telephone Number	:	225-654-4290
Fax Number	:	225-654-0102

Provider Business Practice Location Address
First Line	:	9305 MAIN ST
Second Line	:	SUITE D
City	:	ZACHARY
State	:	LA
Zip	:	70791-7441
Country	:	US
Telephone Number	:	225-654-4290
Fax Number	:	225-654-0102

Authorized Official
Title or Position	:	OWNER OFFICE MANAGER
Name	:	DEWITT GINN
Credential	:
Telephone Number	:	225-654-4290

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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Directions to “MEDAMERICA LLC ” Practice Location

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