| Christus Health Central Louisiana | |
| 
					132 Cherry St Provencal LA 71468  | |
| (318) 472-8660 | |
| (318) 472-8661 | 
| Full Name | Christus Health Central Louisiana | 
|---|---|
| Speciality | Clinic/center - Student Health | 
| Location | 132 Cherry St, Provencal, 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 3330 Masonic Dr Alexandria LA 71301-3841 Ph: (318) 483-4031  | Christus Health Central Louisiana 132 Cherry St Provencal LA 71468 Ph: (318) 472-8660  | 
| NPI Number | 1164687307 | 
|---|---|
| Provider Enumeration Date | 07/28/2008 | 
| Last Update Date | 10/19/2022 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1164687307 | NPI | - | NPPES | 
| 1808814 | Medicaid | LA | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QS1000X | Clinic/center - Student Health | 234 (Louisiana) | Primary | 
Access Health Louisiana Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 132 Cherry St, Provencal, LA 71468 Phone: 866-530-6111  |