Healthcare Provider Details

I. General information

NPI: 1467757682
Provider Name (Legal Business Name): LOUISIANA MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10466 AIRLINE HWY STE C
BATON ROUGE LA
70816-4047
US

IV. Provider business mailing address

10466 AIRLINE HWY STE C
BATON ROUGE LA
70816-4047
US

V. Phone/Fax

Practice location:
  • Phone: 225-292-1969
  • Fax: 225-292-1960
Mailing address:
  • Phone: 225-292-1969
  • Fax: 225-292-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY BRIAN SONNIER
Title or Position: OWNER
Credential:
Phone: 225-292-1969