| Collective Rural Healthcare System Llc | |
|
4855 Highway 10 West Suite C Elizabeth LA 70638 | |
| (318) 634-5600 | |
| (318) 634-5602 |
| Full Name | Collective Rural Healthcare System Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4855 Highway 10 West, Elizabeth, Louisiana |
| Authorized Official Name and Position | Alec Donovan Jeansonne (CEO) |
| Authorized Official Contact | 3188802144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Collective Rural Healthcare System Llc 912 Bryan St Cottonport LA 71327-4288 Ph: (888) 995-0591 | Collective Rural Healthcare System Llc 4855 Highway 10 West Suite C Elizabeth LA 70638 Ph: (318) 634-5600 |
| NPI Number | 1841908761 |
|---|---|
| Provider Enumeration Date | 11/09/2022 |
| Last Update Date | 11/11/2022 |
| Medicare PECOS PAC ID | 1254701121 |
|---|---|
| Medicare Enrollment ID | O20230111000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841908761 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Herndon Martin Jeansonne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114002698 PECOS PAC ID: 3678587375 Enrollment ID: I20060202000098 |
| Provider Name | Angela D Huval |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639489487 PECOS PAC ID: 4486808763 Enrollment ID: I20130214000368 |
| Provider Name | Paula Gates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013264878 PECOS PAC ID: 6507092822 Enrollment ID: I20131115000224 |
| Provider Name | Heather Johnson Palazzo |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1114322146 PECOS PAC ID: 8820481716 Enrollment ID: I20220217002155 |
| Provider Name | Misty Danielle Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427763085 PECOS PAC ID: 2769855923 Enrollment ID: I20230308003294 |
| Provider Name | Ashley Sarah Farris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881471571 PECOS PAC ID: 9638525744 Enrollment ID: I20231026000288 |
| Provider Name | Laurel Lachelle Sanders |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942865332 PECOS PAC ID: 9830541358 Enrollment ID: I20240122000144 |