Healthcare Provider Details

I. General information

NPI: 1881821247
Provider Name (Legal Business Name): FCC POLLOCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 AIR BASE ROAD HEALTH SERVICES
POLLOCK LA
71467-1000
US

IV. Provider business mailing address

P.O. 1000 HEALTH SERVICES
POLLOCK LA
71467-1000
US

V. Phone/Fax

Practice location:
  • Phone: 318-561-5546
  • Fax: 318-561-5547
Mailing address:
  • Phone: 318-561-5546
  • Fax: 318-561-5547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SPENCER TALMADGE SMITH
Title or Position: HEALTH SERVICES ADMINISTRATOR
Credential: RN
Phone: 318-561-5546