NPIMap

Organization Active NPI

CLHG-Avoyelles LLC

Doing business as Premier Pediatrics of Avoyelles

  • Rural Health Clinic/Center
  • Marksville, LA
National Provider Identifier
1447841945
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLHG-AVOYELLES LLC
Doing business as
Premier Pediatrics of Avoyelles
Practice address
110 La Rue Medecine St
Marksville, LA 71351-2637
Phone
(318) 409-5008
Fax
(318) 409-5009
NPI assigned
Jan 28, 2021
Last updated
Mar 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
Timothey Curry
Title
Ceo
Phone
(318) 240-6000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Pediatric Nurse Practitioner 363LP0200X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

110 La Rue Medecine St
Marksville, LA 71351-2637

Mailing address

PO Box 249
Marksville, LA 71351-0249
Phone (318) 409-5008

Other names 1

  • PREMIER PEDIATRICS OF AVOYELLES Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180828001494 LA Part B Supplier - Clinic/Group Practice 8921380528 Receives reassigned benefits from 87 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marksville, LA; Moreauville, LA; Lecompte, LA; Hessmer, LA; Cottonport, LA
O20210217002650 LA Part A Provider - Rural Health Clinic 8921380528 Practice locations: Marksville, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447841945. Details of each certification follow.

Rural health clinic certification: CCN 198545

Legal name
CLHG-AVOYELLES LLC
Doing business as
PREMIER PEDIATRICS OF AVOYELLES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 10, 2023
Last certification
Nov 10, 2023
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Sep 1, 2018 in LA
Enrollment address
110 La Rue Medecine St
Marksville, LA 71351-2637
Related CCNs
190099

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).

Other NPIs on the same Medicare enrollment 7

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
19D2267877Premier Pediatrics of Avoyelles110 La Rue Medecine, Marksville, LA 71351Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
CLHG-Avoyelles LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

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
Donald Cameron Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2018 30%
Corporate Officer Sep 1, 2018
W-2 Managing Employee Sep 1, 2018
Rock Bordelon Individual 5% Or Greater Direct Ownership Interest Sep 1, 2018 65%
Corporate OfficerBoard Member Sep 1, 2018
Scott Markstrom Individual 5% Or Greater Direct Ownership InterestBoard Member Sep 1, 2019 5%
Cameron Investments LLC Organization, Shreveport, LA LLC 5% Or Greater Direct Ownership Interest Sep 1, 2018 30%

Facilities with the same owner 43

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

View all 43

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1447841945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "MARKSVILLE",
            "state": "LA",
            "postal_code": "713510249",
            "telephone_number": "318-409-5008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LA RUE MEDECINE ST",
            "city": "MARKSVILLE",
            "state": "LA",
            "postal_code": "713512637",
            "telephone_number": "318-409-5008",
            "fax_number": "318-409-5009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLHG-AVOYELLES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-28",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "CURRY",
        "authorized_official_first_name": "TIMOTHEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-240-6000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PREMIER PEDIATRICS OF AVOYELLES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marksville, LA

Sources for this page

Verify at the official NPI Registry.