MEDICARE: INNIS 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
1	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1578986006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNIS COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	6450 LOUISIANA HIGHWAY 1
Second Line	:
City	:	BATCHELOR
State	:	LA
Zip	:	70715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8737 NEWFIELD DRIVE
Second Line	:
City	:	LIVONIA
State	:	LA
Zip	:	70755
Country	:	US
Telephone Number	:	225-637-2323
Fax Number	:	225-637-2327

Authorized Official
Title or Position	:	EXEUTIVE DIRECTOR
Name	:	CINDY PEAVY
Credential	:
Telephone Number	:	225-492-3775

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	11/18/2021

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