MEDICARE: PREEMINENT HEALTHCARE SYSTEMS

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	251S00000X	Community/Behavioral Health Agency	9562	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	:	1891749834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREEMINENT HEALTHCARE SYSTEMS

Provider Business Mailing Address
First Line	:	325 N AVENUE F
Second Line	:
City	:	CROWLEY
State	:	LA
Zip	:	70526-5042
Country	:	US
Telephone Number	:	337-783-5262
Fax Number	:	337-783-5264

Provider Business Practice Location Address
First Line	:	7515 CAMERON ST
Second Line	:
City	:	DUSON
State	:	LA
Zip	:	70529-3312
Country	:	US
Telephone Number	:	337-456-3392
Fax Number	:	337-456-3394

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BRANDY MALLET
Credential	:
Telephone Number	:	337-783-5262

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	12/08/2009

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