Healthcare Provider Details

I. General information

NPI: 1467599530
Provider Name (Legal Business Name): CENLA FAMILY MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 WATER STREET
LECOMPTE LA
71346
US

IV. Provider business mailing address

PO BOX 399
LECOMPTE LA
71346-0399
US

V. Phone/Fax

Practice location:
  • Phone: 318-776-9340
  • Fax: 318-776-8889
Mailing address:
  • Phone: 318-776-9340
  • Fax: 318-776-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02164
License Number StateLA

VIII. Authorized Official

Name: MELANIE L SLAUGHTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-776-9340