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DIVINE HEALTH AND PRIMARY CARE CLINIC
NPI 1548528854
Internal Medicine in Ruston, LA

Active since April 25, 2012
1401 EZELL STREET, RUSTON, LA 71270(318) 259-1204(318) 259-1255 Get Directions Write a Review

NPPES record last updated: April 25, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Divine Health And Primary Care Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DIVINE HEALTH AND PRIMARY CARE CLINIC (NPI 1548528854) is a healthcare organization registered as an internal medicine in Ruston, Louisiana and active in the NPI registry since April 2012. The organization lists Ofundem Rose Gwan, Owner/physician, as its authorized official.

NPPES Registry Identity

NPI1548528854
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameDIVINE HEALTH PRIMARY CARE CLINIC, LLC
Location Address1401 EZELL STREETRuston, LA 71270-7218
Mailing Address1401 Ezell StreetRuston, LA 71270-7218 · (318) 259-1204 · Fax (318) 259-1255
Phone(318) 259-1204
Fax(318) 259-1255
Organization SubpartNo
Authorized OfficialOfundem Rose GwanOwner/physician · (318) 259-1204
Enumeration DateApril 25, 2012
✔ NPI 1548528854 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in LA · 203609
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
1401 EZELL STREET, Ruston, LA 71270
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Other Names 1

Doing Business AsDivine Health And Primary Care Clinic

Other Identifiers 1

Other1245440940LA · Individual Npi

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DAVID LANSON WHEELER PH.D.
Psychologist (Counseling)
1401 EZELL STREET
RUSTON, LA 71270
Lincoln Parish (318) 251-3126
RUSTON PULMONARY AND CRITICAL CARE SPECIALIST, L L C
Internal Medicine (Pulmonary Disease)
1401 EZELL STREET
RUSTON, LA 71270
Lincoln Parish (318) 251-8316

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Divine Health Primary Care Clinic, LLC's NPI number?

The NPI number for Divine Health Primary Care Clinic, LLC is 1548528854. It was assigned to this organization in the NPPES registry on April 25, 2012. The provider is doing business as Divine Health And Primary Care Clinic.

Where is Divine Health Primary Care Clinic, LLC located?

Divine Health Primary Care Clinic, LLC is located at 1401 Ezell Street, Ruston, LA 71270. The listed phone number is (318) 259-1204.

What is Divine Health Primary Care Clinic, LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

When was this NPI record last updated?

The NPPES record for Divine Health Primary Care Clinic, LLC was last updated on April 25, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.