| Innis Community Health Center, Inc | |
|
630 North Vaughn Drive Brusly LA 70719 | |
| (225) 492-3775 | |
| Not Available |
| Full Name | Innis Community Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 630 North Vaughn Drive, Brusly, Louisiana |
| Authorized Official Name and Position | Cindy Griffin Peavy (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2254923775 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innis Community Health Center, Inc 6450 Louisiana Highway 1 Batchelor LA 70715 Ph: (225) 492-3775 | Innis Community Health Center, Inc 630 North Vaughn Drive Brusly LA 70719 Ph: (225) 492-3775 |
| NPI Number | 1013496561 |
|---|---|
| Provider Enumeration Date | 08/07/2018 |
| Last Update Date | 11/18/2021 |
| Medicare PECOS PAC ID | 9931130358 |
|---|---|
| Medicare Enrollment ID | O20180919000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013496561 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Bph Enterprises, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 402 N Vaughan St, Brusly, LA 70719 Phone: 225-749-2645 Fax: 225-749-8216 |