NPIMap

Organization Active NPI

CLHG-Ville Platte LLC

  • Rural Health Clinic/Center
  • Ville Platte, LA
National Provider Identifier
1265032676
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLHG-VILLE PLATTE LLC
Practice address
421 Jack Miller Rd
Ville Platte, LA 70586-5613
Phone
(337) 363-4499
Fax
(337) 363-4990
NPI assigned
Oct 27, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Authorized official

Name
Kristopher Aguillard
Title
Coo
Phone
(337) 363-9486

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

421 Jack Miller Rd
Ville Platte, LA 70586-5613

Mailing address

421 Jack Miller Rd
Ville Platte, LA 70586-5613
Phone (337) 363-4499

Other names 1

  • Fontenot Internal Medicine Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201207002431 LA Part A Provider - Rural Health Clinic 4486903309 Practice locations: Ville Platte, LA

Rural health clinic certification: CCN 198537

Legal name
CLHG-VILLE PLATTE LLC
Doing business as
FONTENOT INTERNAL MEDICINE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 26, 2021
Last certification
Oct 26, 2021
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Mar 7, 2018 in LA
Enrollment address
421 Jack Miller Rd
Ville Platte, LA 70586-5613
Related CCNs
190167

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

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
CLHG-Ville Platte LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

421 Jack Miller Rd
Ste A
Ville Platte, LA 70586
Phone (337) 942-3263

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Rock Bordelon Individual 5% Or Greater Direct Ownership Interest Nov 1, 2020 80%
Allegiance Health Management Inc Organization, Bossier City, LA Corporation Limited Partnership Interest Aug 1, 2018
Operational/Managerial Control Nov 1, 2020
Kevin Ardoin Individual Corporate OfficerCeo Jan 1, 2026 100%
W-2 Managing EmployeeCeo Jan 1, 2026 100%
Cameron Investments LLC Organization, Shreveport, LA LLC 5% Or Greater Direct Ownership Interest Nov 1, 2020 16%

Facilities with the same owner 53

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

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1265032676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 JACK MILLER RD",
            "city": "VILLE PLATTE",
            "state": "LA",
            "postal_code": "705865613",
            "telephone_number": "337-363-4499",
            "fax_number": "337-363-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 JACK MILLER RD",
            "city": "VILLE PLATTE",
            "state": "LA",
            "postal_code": "705865613",
            "telephone_number": "337-363-4499",
            "fax_number": "337-363-4990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLHG-VILLE PLATTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-27",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "AGUILLARD",
        "authorized_official_first_name": "KRISTOPHER",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "337-363-9486"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal 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": "Fontenot Internal Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ville Platte, LA

Sources for this page

Verify at the official NPI Registry.