Organization
CCP PRIMARY CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GROVER PHIPPS (MANAGING PARTNER)
(337) 289-6690
Entity
Organization
Contact information
Practice address
1101 ERASTE LANDRY RD, LAFAYETTE, LA 70506-3043
(337) 289-6690
Mailing address
1101 ERASTE LANDRY RD, LAFAYETTE, LA 70506-3043
(337) 289-6690
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
022833
LA
363L00000X
Nurse Practitioner
Primary
AP04512
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14-47692
—
LA
Enumeration date
02/24/2006
Last updated
09/11/2025
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