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General NPI Number Information
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NPI Number | 1003297227
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Entity Type | Organization
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Legal Business Name | AFFINITY HEALTH GROUP, LLC
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 920 OLIVER RD SUITE C
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City | MONROE
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State | LA
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Zip | 71201-5702
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Country | US
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Telephone | 318-812-7050
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Fax | 318-812-7053
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Provider Business Mailing Address
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Address Line | 130 DESIARD ST SUITE 355
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City | MONROE
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State | LA
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Zip | 71201-7319
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Country | US
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Telephone | 318-807-7875
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Fax | 318-812-6603
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MIKE BREARD
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Credential |
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Telephone | 318-361-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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