Healthcare Provider Details

I. General information

NPI: 1598715898
Provider Name (Legal Business Name): CALHOUN FAMILY CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 CYPRESS ST SUITE 9
WEST MONROE LA
71291-5286
US

IV. Provider business mailing address

3101 CYPRESS ST SUITE 9
WEST MONROE LA
71291-5286
US

V. Phone/Fax

Practice location:
  • Phone: 318-644-2573
  • Fax: 318-644-7177
Mailing address:
  • Phone: 318-644-2573
  • Fax: 318-644-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number261QH0100X
License Number StateLA

VIII. Authorized Official

Name: MRS. RITA D ZUBER
Title or Position: OWNER/FNP
Credential: FNP
Phone: 318-644-2573