Provider Demographics
NPI:1417608803
Name:CLHG-LEESVILLE
Entity Type:Organization
Organization Name:CLHG-LEESVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR OF CLINIC OPS
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 1:927 VERONE TER
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:927 VERONE TER
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4255
Practice Address - Country:US
Practice Address - Phone:337-238-1049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLHG-LEESVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-17
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty