| Pineville Elementary School Based Clinic | |
|
835 Main St Pineville LA 71360-6405 | |
| (318) 442-8154 | |
| Not Available |
| Full Name | Pineville Elementary School Based Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 835 Main St, Pineville, Louisiana |
| Authorized Official Name and Position | Deano Thornton (CEO) |
| Authorized Official Contact | 3186480375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pineville Elementary School Based Clinic Po Box 1288 Winnfield LA 71483-1288 Ph: (318) 209-4510 | Pineville Elementary School Based Clinic 835 Main St Pineville LA 71360-6405 Ph: (318) 442-8154 |
| NPI Number | 1982268769 |
|---|---|
| Provider Enumeration Date | 04/26/2019 |
| Last Update Date | 07/20/2022 |
| Certification Date | 07/20/2022 |
| Medicare PECOS PAC ID | 2567516545 |
|---|---|
| Medicare Enrollment ID | O20210503001695 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982268769 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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