Provider Demographics
NPI:1437746948
Name:VIDRINE RURAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:VIDRINE RURAL HEALTH CLINIC LLC
Other - Org Name:VIDRINE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAHAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-506-3500
Mailing Address - Street 1:4940 VIDRINE RD STE F
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-8780
Mailing Address - Country:US
Mailing Address - Phone:337-506-3500
Mailing Address - Fax:888-927-0698
Practice Address - Street 1:4940 VIDRINE RD STE F
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-8780
Practice Address - Country:US
Practice Address - Phone:337-506-3500
Practice Address - Fax:888-927-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty