Provider Demographics
NPI:1003960535
Name:DREW OUTPATIENT CLINIC, LLC
Entity Type:Organization
Organization Name:DREW OUTPATIENT CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER,CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:EPPINETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-329-4370
Mailing Address - Street 1:1117 CHENIERE DREW RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8551
Mailing Address - Country:US
Mailing Address - Phone:318-329-4370
Mailing Address - Fax:318-329-4356
Practice Address - Street 1:1117 CHENIERE DREW RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-8551
Practice Address - Country:US
Practice Address - Phone:318-329-4370
Practice Address - Fax:318-329-4356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018471261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB62541Medicare UPIN
LA018471Medicare ID - Type UnspecifiedDR. JAMES EPPINETTE