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Organization
CCP MEDICAL MANAGEMENT, LLC
Active
Organization
CCP MEDICAL MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GROVER PHIPPS (PARTNER)
(337) 896-6400
Entity
Organization
Contact information
Practice address
213 FOURPARK RD, SUITE C, LAFAYETTE, LA 70507-2481
(337) 896-6400
(337) 896-6441
Mailing address
213 FOURPARK RD, SUITE C, LAFAYETTE, LA 70507-2481
(337) 896-6400
(337) 896-6441
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
026036
LA
Other
Enumeration date
01/14/2008
Last updated
01/14/2008
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