Provider Demographics
NPI:1033700539
Name:CLHG-LEESVILLE
Entity Type:Organization
Organization Name:CLHG-LEESVILLE
Other - Org Name:LUBBOS MEDICAL PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR OF CLINIC OPERATI
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HIPPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-315-7093
Mailing Address - Street 1:1020 W FERTITTA BLVD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 S ARKANSAS STREET
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446
Practice Address - Country:US
Practice Address - Phone:337-239-7227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health