Provider Demographics
NPI:1851374748
Name:WEST CARROLL HEALTH SYSTEMS LLC
Entity Type:Organization
Organization Name:WEST CARROLL HEALTH SYSTEMS LLC
Other - Org Name:LAKE PROVIDENCE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-428-3237
Mailing Address - Street 1:706 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-9798
Mailing Address - Country:US
Mailing Address - Phone:318-559-1221
Mailing Address - Fax:318-559-3321
Practice Address - Street 1:319 N HOOD ST
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-2141
Practice Address - Country:US
Practice Address - Phone:318-559-1221
Practice Address - Fax:318-559-3321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1944521Medicaid
LA1944521Medicaid