Organization
START COMMUNITY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER G. BENNETT APRN (OWNER)
(318) 728-4368
Entity
Organization
Contact information
Practice address
5975 FEDERAL 80 HWY, RAYVILLE, LA 71269-7750
(318) 728-4368
(318) 728-4397
Mailing address
PO BOX 367, START, LA 71279-0367
(318) 728-4368
(318) 728-4397
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
141
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027481
—
LA
05
—
1450791
—
LA
Enumeration date
05/07/2009
Last updated
08/05/2009
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