Provider Demographics
NPI:1669443487
Name:CLECO PRIMARY CARE NETWORK
Entity Type:Organization
Organization Name:CLECO PRIMARY CARE NETWORK
Other - Org Name:CLECO MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:HOYLE
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-480-1087
Mailing Address - Street 1:808 SCHENCK STREET
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3934
Mailing Address - Country:US
Mailing Address - Phone:704-480-9344
Mailing Address - Fax:704-484-3260
Practice Address - Street 1:808 SCHENCK STREET
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:704-480-9344
Practice Address - Fax:704-484-3260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLECO PRIMARY CARE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-30
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343970AMedicaid
NC343970CMedicaid
NC2343862Medicare PIN
NC343970CMedicaid