Divine Health Primary Care Clinic, LLC
Divine Health Primary Care Clinic, LLC is an Internal Medicine Physician in Ruston, Louisiana. Licensed in Louisiana. Registered with an NPI since 2012.
- Licensed in
- LA
- In the registry since
- 2012
What do these letters mean?
- LLC — Limited liability company
- A form of business registration, not a clinical qualification.
Practice location Address checks out
1401 Ezell StRuston, LA 71270-7218
Phone: (318) 259-1204
Fax: (318) 259-1255
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Internal Medicine Physician (primary) | Taxonomy 207R00000X · Licence 203609 (LA) |
|---|
Record details
| NPI number | 1548528854 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Ofundem Gwan — Owner/Physician · (318) 259-1204 |
| Other names | Divine Health And Primary Care Clinic |
| NPI enumerated | April 25, 2012 |
| Last updated in NPPES | April 25, 2012 |
| Mailing address | 1401 Ezell Street, Ruston, LA 71270-7218 |
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Mr. Mark Blackwelder, MD
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Glenn Figueroa MD APMC
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Ofundem Rose Gwan, MD
1406 S Vienna St, Ruston, LA 71270-6428 · (318) 232-2456
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Mr. Allan Hild, MD
1200 S Farmerville St, Ruston, LA 71270-5941 · (318) 255-3690