MEDICARE: CHRISTUS HEALTH CENTRAL LOUISIANA

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
2	261QC0050X	Critical Access Hospital Clinic/Center	551RHC-1	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	:	1871584722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTUS HEALTH CENTRAL LOUISIANA

Provider Business Mailing Address
First Line	:	PO BOX 847329
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7329
Country	:	US
Telephone Number	:	800-756-7999
Fax Number	:	469-282-1791

Provider Business Practice Location Address
First Line	:	1633 MARVEL STREET
Second Line	:
City	:	COUSHATTA
State	:	LA
Zip	:	71019-9022
Country	:	US
Telephone Number	:	318-932-2081
Fax Number	:	318-932-2215

Authorized Official
Title or Position	:	CEO
Name	:	MONTE WILSON
Credential	:
Telephone Number	:	337-470-2100

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	10/20/2022

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Directions to “CHRISTUS HEALTH CENTRAL LOUISIANA ” Practice Location

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