# CHACHERE PROVOST MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780875740
- **Authorized official:** DR. HOLLY C. PROVOST M.D. (OWNER)
- **Authorized official phone:** (337) 942-2323

## Contact information

- **Practice address:** 3975 I 49 S SERVICE RD, SUITE 205A, OPELOUSAS, LA 70570-0775
- **Practice address phone:** (337) 942-2323
- **Practice address fax:** (337) 942-2626
- **Mailing address:** 3975 I 49 S SERVICE RD, SUITE 205A, OPELOUSAS, LA 70570-0775
- **Mailing address phone:** (337) 942-2323
- **Mailing address fax:** (337) 942-2626

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/06/2007
- **Last updated:** 02/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0701037 | UNITED HEALTHCARE | — |
| 05 | — | 1571831 | — | LA |
| 01 | — | 160059334 | RAILROAD MEDICARE | — |
| 01 | — | 4389889160 | BLUE CROSS BLUE SHIELD OF | LA |
| 01 | — | 7352418 | AETNA | — |