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General NPI Number Information
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NPI Number | 1831491141
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Entity Type | Organization
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Legal Business Name | KISATCHIE MEDICAL LLC
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 3425 NORTH BLVD STE A
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3608
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Country | US
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Telephone | 318-473-1921
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Fax | 318-473-1922
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Provider Business Mailing Address
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Address Line | 3425 NORTH BLVD STE A
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3608
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Country | US
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Telephone | 318-473-1921
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Fax | 318-473-1922
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. WENDY CHRISTINA GODEAUX
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Credential |
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Telephone | 318-473-1921
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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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