Healthcare Provider Details

I. General information

NPI: 1780341271
Provider Name (Legal Business Name): FAMILY MEDICINE CENTER OF RESERVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 CENTRAL AVE
RESERVE LA
70084-6001
US

IV. Provider business mailing address

147 CENTRAL AVE
RESERVE LA
70084-6001
US

V. Phone/Fax

Practice location:
  • Phone: 985-536-2605
  • Fax:
Mailing address:
  • Phone: 985-536-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CYNTHIA ALBRECHT
Title or Position: SOLE OWNER
Credential: NP
Phone: 985-536-2605