Organization
CHACHERE PROVOST MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOLLY C. PROVOST M.D. (OWNER)
(337) 942-2323
Entity
Organization
Contact information
Practice address
3975 I 49 S SERVICE RD, SUITE 205A, OPELOUSAS, LA 70570-0775
(337) 942-2323
(337) 942-2626
Mailing address
3975 I 49 S SERVICE RD, SUITE 205A, OPELOUSAS, LA 70570-0775
(337) 942-2323
(337) 942-2626
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0701037
UNITED HEALTHCARE
—
05
—
1571831
—
LA
01
—
160059334
RAILROAD MEDICARE
—
01
—
4389889160
BLUE CROSS BLUE SHIELD OF
LA
01
—
7352418
AETNA
—
Enumeration date
08/06/2007
Last updated
02/29/2008
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