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	261QR1300X	Rural Health Clinic/Center

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	:	1659351724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLECO PRIMARY CARE NETWORK

Provider Business Mailing Address
First Line	:	808 SCHENCK STREET
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-3934
Country	:	US
Telephone Number	:	704-480-1087
Fax Number	:	704-484-3260

Provider Business Practice Location Address
First Line	:	5009 FALLSTON ROAD
Second Line	:
City	:	LAWNDALE
State	:	NC
Zip	:	28090
Country	:	US
Telephone Number	:	704-480-9344
Fax Number	:	704-538-5803

Authorized Official
Title or Position	:	FINANCIAL MANAGER
Name	:	MRS. MICHELLE HOYLE JORDAN
Credential	:
Telephone Number	:	704-480-1087

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	03/21/2019

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Directions to “CLECO PRIMARY CARE NETWORK ” Practice Location

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