Swla Center for Health Services
Organization Active NPI Federally Qualified Health Center (FQHC) · Oberlin, LA
NPI 1942645007 · NPPES record last updated May 13, 2019
Key facts
- NPI
- 1942645007
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SWLA CENTER FOR HEALTH SERVICES
- Practice address
- 112 N. Sixth Street
Oberlin, LA 70655 - Phone
- (337) 639-2281
- Fax
- (337) 639-6199
- NPI assigned
- May 2, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- SWLA CENTER FOR HEALTH SERVICES
Authorized official
- Name
- Kobrina Price
- Title
- Revenue Cycle Manager
- Phone
- (337) 493-5112
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 11
Practitioners 40
-
Ronnell Jones, NP
-
Tammy Mitchell, M.D.
-
Bradley Michael Blappert, M.D.
-
Natalie Culpepper, APRN
-
Angie Ewalt Dukes, FNP-C
-
Danette Marie Duval, APRN-BC
-
James Phillip Gaharan, M.D.
-
Candace Douglas Gilmore, M.D.
-
Todd M Leleux, M.D.
-
Gilbert Anson Lyon III, LCSW
-
Stacey B Molinere, F.N.P.
-
Phoenicia Neveu, NP-C
-
Anthony Perry, DPM
-
Melissa Purvis, FNP-C
-
Lindsey A Rhodes, PA-C
-
Ghyass Rizk, MD
-
Jennifer Russo, PMHNP
-
Joi Rinae Thomas, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in LA
Federally qualified health center certification: CCN 191915
- Legal name
- SWLA CENTER FOR HEALTH SERVICES
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 13, 2014
- Last certification
- May 13, 2014
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 25, 1978 in LA
- Enrollment address
- 112 N Sixth St
Oberlin, LA 70655-6109
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Mandi D Mitchell |
Corporate Director |
Jan 28, 2008 | |
| Sandra P Semien |
Corporate Director |
Jun 6, 2001 | |
| Paulette Lofton |
Corporate Officer |
Apr 29, 2021 | |
| Clyde W Mitchell |
Corporate Director |
Jun 6, 2001 | |
| Bernita Brown |
Corporate Director |
Jan 28, 2008 | |
| William Brent |
W-2 Managing Employee |
Feb 15, 2021 | |
| Other |
Feb 15, 2021 | ||
| Barbara Hardy |
Corporate Director |
Jun 6, 2001 | |
| Chee NG |
Other |
Nov 16, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040109000902 | LA | Part B Supplier - Clinic/Group Practice | 9133029853 |
Receives reassigned benefits from 36 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Crowley, LA; Lafayette, LA; Lake Charles, LA; Oberlin, LA |
| O20140521000404 | LA | Part a Provider - Federally Qualified Health Center (FQHC) | 9133029853 | Practice locations: Oberlin, LA |
National Provider Directory
- Tax ID family
- Bayou Comprehensive Hea
- Part of
- Bayou Comprehensive Hea
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
112 N. Sixth Street
Oberlin, LA 70655
Mailing address
2000 Opelousas Street
Lake Charles, LA 70601
Phone (337) 439-9983
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2351150 | Medicaid | LA |
Other providers in Oberlin, LA
- Carly J Robinson Haftmann
- Sacred Heart Management LLC
- Savoy Medical Management Group, Inc
- St Frances Pfu LLC
- Steves Family Pharmacy
- Colleen H Unkel
- Vitality Senior Services, LLC
- Briana West
All providers in Oberlin, LA · Federally Qualified Health Center (FQHC) in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.