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General NPI Number Information
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NPI Number | 1174681647
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Entity Type | Organization
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Legal Business Name | AVOYELLES ADULT CARE A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 4239 HIGHWAY 1192 SUITE 200
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City | MARKSVILLE
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State | LA
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Zip | 71351-2956
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Country | US
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Telephone | 318-253-8600
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Fax | 318-253-8654
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Provider Business Mailing Address
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Address Line | 4239 HIGHWAY 1192 SUITE 200
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City | MARKSVILLE
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State | LA
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Zip | 71351-4771
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Country | US
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Telephone | 318-253-8600
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Fax | 318-253-8654
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KIMBERLY O CORLEY
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Credential |
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Telephone | 318-253-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 023281
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License Number State | LA
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