Healthcare Provider Details

I. General information

NPI: 1407888209
Provider Name (Legal Business Name): WK BUTLER-ABSHIRE MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 FRANCES DR
HAYNESVILLE LA
71038-6100
US

IV. Provider business mailing address

PO BOX 271
HAYNESVILLE LA
71038-0271
US

V. Phone/Fax

Practice location:
  • Phone: 318-624-0554
  • Fax: 318-624-3782
Mailing address:
  • Phone: 318-624-0554
  • Fax: 318-624-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREG J GAVIN
Title or Position: NETWORK ADMINISTRATOR
Credential:
Phone: 318-624-0554