| Phsc Dental Clinic | |
|
2914 Betin Ave Monroe LA 71201-7258 | |
| (318) 323-4450 | |
| (318) 323-4430 |
| Full Name | Phsc Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2914 Betin Ave, Monroe, Louisiana |
| Authorized Official Name and Position | Catherine M Tonore (CEO) |
| Authorized Official Contact | 3183881250 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phsc Dental Clinic Po Box 7495 Monroe LA 71211-7495 Ph: (318) 388-1250 | Phsc Dental Clinic 2914 Betin Ave Monroe LA 71201-7258 Ph: (318) 323-4450 |
| NPI Number | 1053604892 |
|---|---|
| Provider Enumeration Date | 05/26/2011 |
| Last Update Date | 04/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053604892 | NPI | - | NPPES |
| 2177427 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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