Desoto Healthcare Center Inc.
Organization Active NPI Family Medicine Physician · Mansfield, LA
NPI 1811209232 · NPPES record last updated Dec 23, 2011
Key facts
- NPI
- 1811209232
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD199935 (LA)
- Legal business name
- DESOTO HEALTHCARE CENTER INC.
- Practice address
- 938 Louise St
Mansfield, LA 71052 - Phone
- (318) 871-1633
- Fax
- (318) 871-1677
- NPI assigned
- Jul 14, 2010
- Organization subpart
- No
Authorized official
- Name
- Ms. Connie B Gannon, FNP
- Title
- Family Nurse Practitioner
- Phone
- (318) 871-1633
National Provider Directory
Locations
7356 Highway 509
Mansfield, LA 71052
Phone (318) 871-1633
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | MD199935 | LA | Yes |
| Nephrology Physician |
207RN0300X | 1487481 | LA | |
| Pediatrics Physician |
208000000X | 1996971 | LA | |
| Family Nurse Practitioner |
363LF0000X | 03124 | LA | |
| Family Nurse Practitioner |
363LF0000X | 020173 | LA |
Addresses
Primary practice location
938 Louise St
Mansfield, LA 71052
Mailing address
PO Box 1384
Mansfield, LA 71052-1384
Phone (318) 871-1633
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2117629 | Medicaid | LA |
Other providers in Mansfield, LA
- Department of Health & Hospitals
- Desoto Council on Aging
- Desoto Council on Aging, Inc.
- Desoto Council on the Aging
- Desoto Council on the Aging, Inc.
- Desoto Hospital Association
- Desoto Hospital Association
- Desoto Hospital Association
- Desoto Hospital Association
- Desoto Hospital Association
All providers in Mansfield, LA · Family Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.