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General NPI Number Information
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NPI Number | 1407888209
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Entity Type | Organization
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Legal Business Name | WK BUTLER-ABSHIRE MEDICAL CLINIC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 926 FRANCES DR
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City | HAYNESVILLE
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State | LA
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Zip | 71038-6100
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Country | US
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Telephone | 318-624-0554
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Fax | 318-624-3782
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Provider Business Mailing Address
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Address Line | PO BOX 271
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City | HAYNESVILLE
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State | LA
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Zip | 71038-0271
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Country | US
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Telephone | 318-624-0554
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Fax | 318-624-3782
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Authorized Official
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Title or Position | NETWORK ADMINISTRATOR
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Name | GREG J GAVIN
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Credential |
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Telephone | 318-624-0554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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