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General NPI Number Information
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NPI Number | 1750588547
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Entity Type | Organization
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Legal Business Name | LINCOLN FAMILY HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 604 BELUE LANE SUITE B
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City | RUSTON
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State | LA
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Zip | 71270
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Country | US
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Telephone | 318-251-6385
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Fax | 318-255-7530
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Provider Business Mailing Address
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Address Line | 1003 WHITE ST
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City | RUSTON
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State | LA
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Zip | 71270
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Country | US
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Telephone | 318-251-6385
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Fax | 318-255-7530
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFERY A BENNETT
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Credential | D. O. PHARMACY
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Telephone | 318-251-6385
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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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