NPIMap

CLHG-Leesville

Organization Active NPI Rural Health Clinic/Center · Rosepine, LA

NPI 1982164224 · NPPES record last updated Mar 16, 2023

Key facts

NPI
1982164224
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
CLHG-LEESVILLE
Practice address
18570 Johnny B. Hall Memorial Hwy
U.S. Route 171
Rosepine, LA 70659
Phone
(337) 462-1913
Fax
(337) 462-1898
NPI assigned
Mar 22, 2019
Organization subpart
No

Authorized official

Name
Donald E. Cameron
Title
Board Member
Phone
(318) 226-8202

Other NPIs on the same Medicare enrollment 8

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

Other NPIs with the same Medicare PAC ID 9

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

Corporate family (same tax ID) 12

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

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

Facilities with the same owner 53

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

View all 53

Practitioners 25

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D1046954West Louisiana Family Practice-Rosepine
18570 Johnny B Hall Road, Rosepine, LA 70659		Certificate of waiverAug 31, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in LA

Rural health clinic certification: CCN 198517

Legal name
CLHG-LEESVILLE
Doing business as
WEST LOUISIANA FAMILY PRACTICE-ROSEPINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 23, 2019
Last certification
Oct 23, 2025
Ownership / control type
For profit – corporation
Organization structure
LLC · Proprietary
Incorporated
Feb 28, 2018 in LA
Enrollment address
18570 Johnny B. Hall Memorial Hwy
U.S.Route 171
Rosepine, LA 70659-0001
Related CCNs
190164

All disclosed owners & managing parties 6

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
Board Member		 Jun 1, 2018 16%
Corporate Officer
Board Member		 Jul 31, 2019
Corporate Director
Board Member		 Jul 31, 2019
Operational/Managerial Control
Board Member		 Jul 31, 2019
Rock Bordelon
Individual 		5% Or Greater Direct Ownership Interest
Board Member		 Jul 31, 2019 80%
Corporate Officer
Board Member		 Jul 31, 2019
Kevin Quinn
Individual 		Corporate Officer
Ceo		 Jan 1, 2024 100%
Corporate Director
Ceo		 Jan 1, 2024 100%
Operational/Managerial Control
Ceo		 Jan 1, 2024 100%
Allegiance Health Management Inc
Organization · Shreveport, LA
Corporation, For-profit 		Operational/Managerial Control Jul 31, 2019
Scott Markstrom
Individual 		5% Or Greater Direct Ownership Interest
Board Member		 Sep 1, 2016 4%
Cameron Investments LLC
Organization · Shreveport, LA
LLC, For-profit 		5% Or Greater Direct Ownership Interest Jul 31, 2019 16%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190520001228 LA Part a Provider - Rural Health Clinic 4082963301 Practice locations: Rosepine, LA
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

National Provider Directory

Tax ID family
CLHG-Leesville (13 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

18570 Johnny B. Hall Memorial Hwy
U.S. Route 171
Rosepine, LA 70659

Mailing address

1020 W Fertitta Blvd
Leesville, LA 71446-4645
Phone (337) 239-5274

Other names

  • West Louisiana Family Practice-Rosepine Doing business as

Other providers in Rosepine, LA

All providers in Rosepine, LA · Rural Health Clinic/Center in Louisiana

Sources for this page

Verify at the official NPI Registry.