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General NPI Number Information
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NPI Number | 1184052789
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Entity Type | Organization
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Legal Business Name | CENTRAL LA. FAMILY HEALTH AND WELLNESS CENTER
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | 3516 NORTH BLVD SUITE A
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3613
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Country | US
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Telephone | 318-441-2220
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Fax | 318-441-2205
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Provider Business Mailing Address
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Address Line | 3516 NORTH BLVD SUITE A
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3613
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Country | US
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Telephone | 318-441-2220
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Fax | 318-441-2205
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BRIAN L ELKINS
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Credential | M.D.
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Telephone | 318-441-2220
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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 | MD13101R
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License Number State | LA
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