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Contact Information

CCP PRIMARY CARE CENTER
1101 ERASTE LANDRY RD
LAFAYETTE, LA70506-3043
 Phone: 337-289-6690
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Pain Medicine

208VP0000X 72 Physician/Pain Management
Indicates primary specialty

NPI Profile & details for CCP PRIMARY CARE CENTER

NPI # 1336115997
LBN Legal business name CCP PRIMARY CARE CENTER
Authorized official GROVER PHIPPS - (MANAGING PARTNER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/24/2006
Last updated 09/11/2025 - About 9 months ago
Identifiers
LA License # 022833
LA License # AP04512
LA Medicaid 14-47692
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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