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Organization
CLHG-RUSTON LLC
Active
Organization
CLHG-RUSTON LLC
Active
Other names
Ruston Physician Practices
Organization subpart
No
Provider details
NPI number
Authorized official
ROCK MATTHEW BORDELON (OWNER)
(318) 629-3269
Entity
Organization
Contact information
Practice address
401 E VAUGHN AVE, RUSTON, LA 71270-5950
(318) 254-2100
Mailing address
401 E VAUGHN AVE, RUSTON, LA 71270-5950
(318) 254-2453
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
07/11/2022
Last updated
09/06/2022
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