Healthcare Provider Details

I. General information

NPI: 1013546720
Provider Name (Legal Business Name): COMMUNITY FAMILY MEDICAL CLINIC OF BUNKIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W MAGNOLIA ST STE 2
BUNKIE LA
71322-1706
US

IV. Provider business mailing address

PO BOX 67
VILLE PLATTE LA
70586-0067
US

V. Phone/Fax

Practice location:
  • Phone: 318-346-2288
  • Fax: 318-346-2299
Mailing address:
  • Phone: 337-945-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMY LEDOUX
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-945-1366