Provider Demographics
NPI:1952622664
Name:CCP MEDICAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:CCP MEDICAL MANAGEMENT LLC
Other - Org Name:PHIPPS MANAGEMENT LLC MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GROVER
Authorized Official - Middle Name:
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-896-6400
Mailing Address - Street 1:213 FOURPARK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-2481
Mailing Address - Country:US
Mailing Address - Phone:337-896-6400
Mailing Address - Fax:337-896-6441
Practice Address - Street 1:213 FOURPARK RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-2481
Practice Address - Country:US
Practice Address - Phone:337-896-6440
Practice Address - Fax:337-896-6441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care