Healthcare Provider Details

I. General information

NPI: 1285549782
Provider Name (Legal Business Name): CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 SCENIC HWY
BATON ROUGE LA
70802-3380
US

IV. Provider business mailing address

PO BOX 66156
BATON ROUGE LA
70896-6156
US

V. Phone/Fax

Practice location:
  • Phone: 225-650-2088
  • Fax: 225-650-2092
Mailing address:
  • Phone: 225-650-2088
  • Fax: 225-650-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW VALLIERE
Title or Position: CEO
Credential:
Phone: 225-650-2026