Healthcare Provider Details

I. General information

NPI: 1831144021
Provider Name (Legal Business Name): BERNICE MEDICAL ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SECOND ST.
BERNICE LA
71222
US

IV. Provider business mailing address

PO BOX 841
BERNICE LA
71222-0841
US

V. Phone/Fax

Practice location:
  • Phone: 318-285-9066
  • Fax: 318-285-9065
Mailing address:
  • Phone: 318-285-9066
  • Fax: 318-285-9065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: DR. ROBERT BRIAN HARRIS
Title or Position: PARTNER
Credential: M.D.
Phone: 318-285-9066