| Mgh Rural Health Clinic | |
|
420 Gunby Ave Bastrop LA 71220-4406 | |
| (318) 283-3920 | |
| (318) 239-8920 |
| Full Name | Mgh Rural Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 420 Gunby Ave, Bastrop, Louisiana |
| Authorized Official Name and Position | Derrick A Frazier (CEO) |
| Authorized Official Contact | 3182833601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mgh Rural Health Clinic Po Box 293 Bastrop LA 71221-0293 Ph: (318) 283-3620 | Mgh Rural Health Clinic 420 Gunby Ave Bastrop LA 71220-4406 Ph: (318) 283-3920 |
| NPI Number | 1245544923 |
|---|---|
| Provider Enumeration Date | 08/05/2010 |
| Last Update Date | 11/22/2019 |
| Medicare PECOS PAC ID | 4284528274 |
|---|---|
| Medicare Enrollment ID | O20101105000653 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245544923 | NPI | - | NPPES |
| 2302914 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
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