Healthcare Provider Details

I. General information

NPI: 1073620191
Provider Name (Legal Business Name): JIMMIE W VARNADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6214 HWY 10
GREENSBURG LA
70441
US

IV. Provider business mailing address

6214 HWY 10 P. O. BOX 1178
GREENSBURG LA
70441
US

V. Phone/Fax

Practice location:
  • Phone: 225-222-3206
  • Fax: 225-222-3190
Mailing address:
  • Phone: 225-222-3206
  • Fax: 225-222-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011614
License Number StateLA

VIII. Authorized Official

Name: DR. JIMMIE W VANRNDO
Title or Position: OWNER
Credential: MD
Phone: 225-222-3206