Healthcare Provider Details

I. General information

NPI: 1952626947
Provider Name (Legal Business Name): CHOICES FAMILY MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6685 SULLIVAN RD
GREENWELL SPRINGS LA
70739-3112
US

IV. Provider business mailing address

6639 SULLIVAN RD
GREENWELL SPRINGS LA
70739-3112
US

V. Phone/Fax

Practice location:
  • Phone: 800-256-3947
  • Fax: 800-609-1694
Mailing address:
  • Phone: 225-261-0160
  • Fax: 225-775-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANNETTE AUSTIN
Title or Position: CEO
Credential:
Phone: 225-261-0160