Healthcare Provider Details

I. General information

NPI: 1366672016
Provider Name (Legal Business Name): RAYVILLE FAMILY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 JULIA ST
RAYVILLE LA
71269-5527
US

IV. Provider business mailing address

PO BOX 658
RAYVILLE LA
71269-0658
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-8833
  • Fax: 318-728-8940
Mailing address:
  • Phone: 318-728-8833
  • Fax: 318-728-8940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number157
License Number StateLA

VIII. Authorized Official

Name: MR. JOSEPH F SYLVESTRI SR.
Title or Position: OWNER
Credential:
Phone: 318-728-8833