NPIMap

Organization Active NPI

CLHG-Leesville

  • Rural Health Clinic/Center
  • Leesville, LA
National Provider Identifier
1194411694
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLHG-LEESVILLE
Practice address
1201 W Fertitta Blvd
Leesville, LA 71446-4637
Phone
(337) 392-9438
NPI assigned
Apr 17, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kevin James Quinn
Title
Ceo
Phone
(337) 239-9041

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1201 W Fertitta Blvd
Leesville, LA 71446-4637

Mailing address

1201 W Fertitta Blvd
Leesville, LA 71446-4637

Other names 1

  • West Louisiana Family Practice - Leesville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200310000179 LA Part B Supplier - Clinic/Group Practice 4082963301 Receives reassigned benefits from 28 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Deridder, LA; Leesville, LA; Rosepine, LA
O20250102002969 LA Part A Provider - Rural Health Clinic 4082963301 Practice locations: Leesville, LA

Rural health clinic certification: CCN 198556

Legal name
CLHG-LEESVILLE
Doing business as
WEST LOUISIANA FAMILY PRACTICE-LEESVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 18, 2025
Last certification
Nov 18, 2025
Ownership / control type
For profit – corporation
Organization structure
LLCProprietary
Enrollment address
1201 W Fertitta Blvd
Leesville, LA 71446-4637
Related CCNs
190164

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2054634West Louisiana Family Practice - Leesville1201 Fertitta Blvd, Leesville, LA 71446Certificate of waiverFeb 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
CLHG-Leesville13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Donald Cameron Individual 5% Or Greater Indirect Ownership Interest Jul 31, 2019 27%
Corporate Officer Jul 31, 2019
Rock Bordelon Individual 5% Or Greater Direct Ownership Interest Jul 31, 2019 65%
Kevin Quinn Individual Corporate OfficerCeo Jul 15, 2019 100%
W-2 Managing EmployeeCeo Jul 15, 2019
Allegiance Health Management Inc Organization, Bossier City, LA Corporation, For-profit Operational/Managerial Control Dec 1, 2021
Cameron Investments LLC Organization, Shreveport, LA For-profit 5% Or Greater Direct Ownership Interest Jul 13, 2019 8%

Facilities with the same owner 53

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 53

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1194411694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 W FERTITTA BLVD",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W FERTITTA BLVD",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464637",
            "telephone_number": "337-392-9438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLHG-LEESVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-17",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "QUINN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-239-9041"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Louisiana Family Practice - Leesville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Louisiana Family Practice - Leesville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leesville, LA

Sources for this page

Verify at the official NPI Registry.