| Dry Prong Family Clinic, Llc | |
| 
					800 Grove Street Dry Prong LA 71423  | |
| (318) 568-8298 | |
| (318) 568-8297 | 
| Full Name | Dry Prong Family Clinic, Llc | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 800 Grove Street, Dry Prong, Louisiana | 
| Authorized Official Name and Position | Benjamin Colvin (OWNER) | 
| Authorized Official Contact | 3185688298 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Dry Prong Family Clinic, Llc Po Box 37 Montgomery LA 71454-0037 Ph: () -  | Dry Prong Family Clinic, Llc 800 Grove Street Dry Prong LA 71423 Ph: (318) 568-8298  | 
| NPI Number | 1366928277 | 
|---|---|
| Provider Enumeration Date | 07/13/2018 | 
| Last Update Date | 06/02/2020 | 
| Medicare PECOS PAC ID | 1759631591 | 
|---|---|
| Medicare Enrollment ID | O20180829001047 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1366928277 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary | 
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary | 
| Provider Name | Benjamin J Colvin | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1730425281 PECOS PAC ID: 9335374586 Enrollment ID: I20131024001527  | 
| Provider Name | Gayle Elliott | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1861988537 PECOS PAC ID: 2365792116 Enrollment ID: I20180829001699  | 
| Provider Name | Amy W Brewer | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1124758081 PECOS PAC ID: 9830566710 Enrollment ID: I20221107000085  | 
| Provider Name | Jessica L Fowler | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1578205829 PECOS PAC ID: 6406209089 Enrollment ID: I20240131000425  | 
Access Health Louisiana Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1000 Highway 1241, Dry Prong, LA 71423 Phone: 866-530-6111  | |
Christus Health Central Louisiana Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17763 Highway 167, Dry Prong, LA 71423 Phone: 318-899-5276 Fax: 318-899-5932  | |
Access Health Louisiana Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 17763 Highway 167, Dry Prong, LA 71423 Phone: 866-530-6111  | |
Winn Community Health Center, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 21239 Highway 167, Dry Prong, LA 71423 Phone: 318-648-0375  |