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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
CATHY WILLIS (MANAGER)
(318) 775-9420
Entity
Organization

Contact information

Practice address
250 COUNTRY CLUB BLVD, MONROE, LA 71202-7302
(318) 775-9420
Mailing address
PO BOX 13124, MONROE, LA 71213-3124
(318) 775-9420

Taxonomy

Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
347C00000X
LA
Enumeration date
04/10/2017
Last updated
04/10/2017
Update your record

If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.

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