MEDICARE: DR. STACY D CONVILLE MD

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	026106	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	:	1497702880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY D CONVILLE MD

Provider Business Mailing Address
First Line	:	902 S VIENNA ST
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-5830
Country	:	US
Telephone Number	:	318-551-4355
Fax Number	:	318-551-4335

Provider Business Practice Location Address
First Line	:	902 S VIENNA ST
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-5830
Country	:	US
Telephone Number	:	318-551-4311
Fax Number	:	318-551-4355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	03/02/2026

Similar Medicare Providers

1396616223 — ADALA HEALTH, LLC
Practice Location Address:

902 S VIENNA ST
RUSTON, LA
71270-5830

Practice Phone: 318-348-1778
Practice Fax:

1821641374 — LATOSHA JACKSON MOLLETTE APRN
Practice Location Address:

902 S VIENNA ST
RUSTON, LA
71270-5830

Practice Phone: 318-551-4311
Practice Fax: 318-551-4355

1417996448 — DR. JERRY ALTON SMITH M.D.
Practice Location Address:

902 S VIENNA ST
RUSTON, LA
71270-5830

Practice Phone: 318-513-1950
Practice Fax: 318-513-1952

1114013182 — DR. WOODY LYLE SMITHEY JR. D.D.S.
Practice Location Address:

900 S VIENNA ST
RUSTON, LA
71270-5830

Practice Phone: 318-251-0334
Practice Fax: 318-255-3538

1992868327 — FAMILY FIRST MEDICINE, APMC
Practice Location Address:

902 S VIENNA ST
RUSTON, LA
71270-5830

Practice Phone: 318-513-1950
Practice Fax: 318-513-1952

1841416781 — JENNIFER HENLEY DDS
Practice Location Address:

900 S VIENNA ST
RUSTON, LA
71270-5830

Practice Phone: 318-251-0334
Practice Fax: 318-255-3538

Directions to “ DR. STACY D CONVILLE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.