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NPI Code Detail

MEDICARE: LOUISIANA FAMILY MEDICINE CLINIC, INC.

MEDICARE: LOUISIANA FAMILY MEDICINE CLINIC, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332900000XNon-Pharmacy Dispensing Site

General Provider Information

NPI Number : 1083094007
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOUISIANA FAMILY MEDICINE CLINIC, INC.
Provider Business Mailing Address
First Line : 103 WATTS ST
Second Line :
City : JONESBORO
State : LA
Zip : 71251-2053
Country : US
Telephone Number : 318-259-1569
Fax Number : 318-259-8523
Provider Business Practice Location Address
First Line : 103 WATTS ST
Second Line :
City : JONESBORO
State : LA
Zip : 71251-2053
Country : US
Telephone Number : 318-259-1569
Fax Number : 318-259-8523
Authorized Official
Title or Position : OWNER
Name : DIRK RAINWATER
Credential : MD
Telephone Number : 318-259-1569
Provider Enumeration Date : 06/04/2015
Last Update Date : 06/04/2015

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Directions to “LOUISIANA FAMILY MEDICINE CLINIC, INC. ” Practice Location

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