Healthcare Provider Details

I. General information

NPI: 1598805434
Provider Name (Legal Business Name): AFFINITY HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 BROADMOOR BLVD STE 2C
MONROE LA
71201-2988
US

IV. Provider business mailing address

130 DESIARD ST STE 355
MONROE LA
71201-7319
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-1161
  • Fax: 318-322-9313
Mailing address:
  • Phone: 318-807-7875
  • Fax: 318-812-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN KAHL
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 318-998-3705