Healthcare Provider Details

I. General information

NPI: 1538397542
Provider Name (Legal Business Name): CENLA FAMILY MEDICINE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1587 N BOLTON AVE SUITE 1100
ALEXANDRIA LA
71303-4217
US

IV. Provider business mailing address

P.O. BOX 5620
BELFAST ME
04915-5600
US

V. Phone/Fax

Practice location:
  • Phone: 318-445-9823
  • Fax: 318-445-1509
Mailing address:
  • Phone: 318-445-9823
  • Fax: 318-445-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number018963
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number015029
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number024254
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number019187
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number303310
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPD20512
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number200010
License Number StateLA
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP01177
License Number StateLA
# 9
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP06478
License Number StateLA
# 10
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP0338
License Number StateLA
# 11
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number018528
License Number StateLA

VIII. Authorized Official

Name: MR. MICHAEL J SCREPETIS
Title or Position: DESIGNATED REGISTERED AGENT
Credential: MD
Phone: 318-445-9823