Willow Chute Medical, LLC
Family Medicine in Bossier City, LA. Organization (NPI-2).
NPI number1033987151
StatusActive
Last updated in NPPESDec 20, 2023
Details
- NPI
- 1033987151
- Entity type
- Organization (NPI-2)
- Legal business name
- Willow Chute Medical, LLC
- Organization subpart
- No
- Enumeration date
- Dec 18, 2023
- Certification date
- Dec 20, 2023
- Last updated
- Dec 20, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
4910 Airline DrBossier City, LA 71111-6607
Phone 318-349-3921
Mailing address
732 Smokehouse LoopBenton, LA 71006-8000
Phone 318-349-3921
Authorized official
Clint N. Wilson
Owner
3183493921
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