Provider Demographics
NPI:1740624139
Name:LMCHH PCP LLC
Entity type:Organization
Organization Name:LMCHH PCP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:985-690-7502
Mailing Address - Street 1:64030 HIGHWAY 434
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-3456
Mailing Address - Country:US
Mailing Address - Phone:985-690-7526
Mailing Address - Fax:985-690-7819
Practice Address - Street 1:1520 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2208
Practice Address - Country:US
Practice Address - Phone:985-649-7295
Practice Address - Fax:985-643-8510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA MEDICAL CENTER AND HEART HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1043996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1305774Medicaid
LA1305774Medicaid