Provider Demographics
NPI:1790713444
Name:FONTENOT HEALTHCARE INC.
Entity Type:Organization
Organization Name:FONTENOT HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-363-4499
Mailing Address - Street 1:421 JACK MILLER RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5613
Mailing Address - Country:US
Mailing Address - Phone:337-363-4499
Mailing Address - Fax:337-363-4990
Practice Address - Street 1:421 JACK MILLER RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5613
Practice Address - Country:US
Practice Address - Phone:337-363-4499
Practice Address - Fax:337-363-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1049484Medicaid
LA5CT46Medicare PIN
LA1049484Medicaid