Provider Demographics
NPI:1679904387
Name:HEALTH CLINIC OF MOSS BLUFF, LLC
Entity Type:Organization
Organization Name:HEALTH CLINIC OF MOSS BLUFF, LLC
Other - Org Name:CHADHA MEDICAL CLINIC - MB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAGJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHADHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-786-5007
Mailing Address - Street 1:140 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-3508
Mailing Address - Country:US
Mailing Address - Phone:337-786-5007
Mailing Address - Fax:337-786-5009
Practice Address - Street 1:237 SAM HOUSTON JONES PKWY
Practice Address - Street 2:
Practice Address - City:MOSS BLUFF
Practice Address - State:LA
Practice Address - Zip Code:70611-5603
Practice Address - Country:US
Practice Address - Phone:337-786-5007
Practice Address - Fax:337-786-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13084R207Q00000X
LA13083R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty