| Willow Chute Medical, Llc | |
|
4910 Airline Dr Bossier City LA 71111-6607 | |
| (318) 349-3921 | |
| Not Available |
| Full Name | Willow Chute Medical, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4910 Airline Dr, Bossier City, Louisiana |
| Authorized Official Name and Position | Clint N. Wilson (OWNER) |
| Authorized Official Contact | 3183493921 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Chute Medical, Llc 732 Smokehouse Loop Benton LA 71006-8000 Ph: (318) 349-3921 | Willow Chute Medical, Llc 4910 Airline Dr Bossier City LA 71111-6607 Ph: (318) 349-3921 |
| NPI Number | 1033987151 |
|---|---|
| Provider Enumeration Date | 12/18/2023 |
| Last Update Date | 12/20/2023 |
| Medicare PECOS PAC ID | 1254784721 |
|---|---|
| Medicare Enrollment ID | O20240131003565 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033987151 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Clint N Wilson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427269059 PECOS PAC ID: 8820142680 Enrollment ID: I20090813000736 |
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