Organization
MEDAMERICA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEWITT GINN (OWNER OFFICE MANAGER)
(225) 654-4290
Entity
Organization
Contact information
Practice address
9305 MAIN ST, SUITE D, ZACHARY, LA 70791-7441
(225) 654-4290
(225) 654-0102
Mailing address
9305 MAIN ST, SUITE D, ZACHARY, LA 70791-7441
(225) 654-4290
(225) 654-0102
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
1416142
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1416142
—
LA
Enumeration date
01/24/2007
Last updated
08/22/2020
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