Healthcare Provider Details

I. General information

NPI: 1750588547
Provider Name (Legal Business Name): LINCOLN FAMILY HEALTH CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 BELUE LANE SUITE B
RUSTON LA
71270
US

IV. Provider business mailing address

1003 WHITE ST
RUSTON LA
71270
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-6385
  • Fax: 318-255-7530
Mailing address:
  • Phone: 318-251-6385
  • Fax: 318-255-7530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFERY A BENNETT
Title or Position: OWNER
Credential: D. O. PHARMACY
Phone: 318-251-6385