Healthcare Provider Details

I. General information

NPI: 1093744146
Provider Name (Legal Business Name): MEDICAL & SURGICAL CLINIC A MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 SOUTH SPRUCE ST
VIVIAN LA
71082-3200
US

IV. Provider business mailing address

1003 SOUTH SPRUCE ST
VIVIAN LA
71082-3200
US

V. Phone/Fax

Practice location:
  • Phone: 318-375-3239
  • Fax: 318-375-2755
Mailing address:
  • Phone: 318-375-3239
  • Fax: 318-375-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA R. HUGHES
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-375-3239