Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
DIVINE HEALTH PRIMARY CARE CLINIC, LLC
Active
Organization
DIVINE HEALTH PRIMARY CARE CLINIC, LLC
Active
Other names
Divine Health and Primary Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OFUNDEM ROSE GWAN M.D. (OWNER/PHYSICIAN)
(318) 259-1204
Entity
Organization
Contact information
Practice address
1401 EZELL STREET, RUSTON, LA 71270-7218
(318) 259-1204
(318) 259-1255
Mailing address
1401 EZELL STREET, RUSTON, LA 71270-7218
(318) 259-1204
(318) 259-1255
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
203609
LA
Other
Enumeration date
04/25/2012
Last updated
04/25/2012
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign upProduct
Developers