| NPI | 1861915415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAVIN F CHICO Md/Owner 318-780-6230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.11956R) |
| Additional Taxonomies | 282E00000X Long Term Care Hospital (Licence: LA MD.11956R) |
| 283X00000X Rehabilitation Hospital (Licence: LA MD.11956R) | |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2018-03-17 |