MEDICARE: LMCHH PCP 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	207Q00000X	Family Medicine Physician	1043996	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	:	1740624139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LMCHH PCP LLC

Provider Business Mailing Address
First Line	:	64030 HIGHWAY 434
Second Line	:
City	:	LACOMBE
State	:	LA
Zip	:	70445-3456
Country	:	US
Telephone Number	:	985-690-7526
Fax Number	:	985-690-7819

Provider Business Practice Location Address
First Line	:	1520 GAUSE BLVD
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70458-2208
Country	:	US
Telephone Number	:	985-649-7295
Fax Number	:	985-643-8510

Authorized Official
Title or Position	:	VP, CLINICAL SERVICES
Name	:	GLENDA P DOBSON
Credential	:	RN,BSN
Telephone Number	:	985-690-7502

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	04/29/2013

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