Provider Demographics
NPI:1477724995
Name:LOUISIANA HEALTH CARE PRACTITIONERS LLC
Entity Type:Organization
Organization Name:LOUISIANA HEALTH CARE PRACTITIONERS LLC
Other - Org Name:COTTONPORT FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-462-0742
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327-1127
Mailing Address - Country:US
Mailing Address - Phone:800-462-0742
Mailing Address - Fax:318-876-3211
Practice Address - Street 1:1007 SYCAMORE ST STE B
Practice Address - Street 2:
Practice Address - City:COTTONPORT
Practice Address - State:LA
Practice Address - Zip Code:71327-3403
Practice Address - Country:US
Practice Address - Phone:800-462-0742
Practice Address - Fax:318-876-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1448575Medicaid
LA1448575Medicaid