| Christus Health Central Louisiana | |
|
1401 Industrial Dr Coushatta LA 71019 | |
| (318) 932-2100 | |
| (318) 932-2010 |
| Full Name | Christus Health Central Louisiana |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1401 Industrial Dr, Coushatta, Louisiana |
| Authorized Official Name and Position | Monte Wilson (CEO) |
| Authorized Official Contact | 3374702100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Christus Health Central Louisiana Po Box 847329 Dallas TX 75284-7329 Ph: (800) 756-7999 | Christus Health Central Louisiana 1401 Industrial Dr Coushatta LA 71019 Ph: (318) 932-2100 |
| NPI Number | 1790767267 |
|---|---|
| Provider Enumeration Date | 11/18/2005 |
| Last Update Date | 10/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790767267 | NPI | - | NPPES |
| 1880795 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 551RHC-1 (Louisiana) | Primary |