Provider Demographics
NPI:1174653588
Name:AMERICAN STAT - CARE CENTERS PC INC
Entity Type:Organization
Organization Name:AMERICAN STAT - CARE CENTERS PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENAKA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:YEMBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-396-3800
Mailing Address - Street 1:PO BOX 2374
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-2374
Mailing Address - Country:US
Mailing Address - Phone:318-396-3800
Mailing Address - Fax:318-396-3852
Practice Address - Street 1:206 BELL LN
Practice Address - Street 2:SUITES C&D
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-6300
Practice Address - Country:US
Practice Address - Phone:318-396-3800
Practice Address - Fax:318-396-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1054453Medicaid
LA4J508Medicare ID - Type Unspecified
LA1054453Medicaid