Organization
VINELCO PHYSICIANS ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAVIN CHICO M.D. (MANAGING PARTNER)
(318) 798-2399
Entity
Organization
Contact information
Practice address
4900 MEDICAL DR, BOSSIER CITY, LA 71112-4521
(318) 932-2081
(318) 932-2215
Mailing address
PO BOX 53032, SHREVEPORT, LA 71135-3032
(318) 932-2081
(318) 932-2215
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
11956R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1315290
—
LA
01
—
DQ1007
RR MEDICARE GROUP NUMBER
LA
Enumeration date
01/26/2007
Last updated
09/08/2015
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