Provider Demographics
NPI:1134136708
Name:CHADHA MEDICAL CLINIC
Entity Type:Organization
Organization Name:CHADHA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAGJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHADHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-786-5007
Mailing Address - Street 1:140 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-3508
Mailing Address - Country:US
Mailing Address - Phone:337-786-5007
Mailing Address - Fax:337-786-5009
Practice Address - Street 1:140 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-3508
Practice Address - Country:US
Practice Address - Phone:337-786-5007
Practice Address - Fax:337-786-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27211261QP2300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Not Answered261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1456128Medicaid
LA1441627Medicaid
LA670200000F5891OtherBCBS PROVIDER NUMBER
LA670200000F5891OtherBCBS PROVIDER NUMBER
LA1441627Medicaid
LA5C681Medicare ID - Type Unspecified
LA1441627Medicaid
LA1456128Medicaid