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General NPI Number Information
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NPI Number | 1972633618
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Entity Type | Organization
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Legal Business Name | ST. MARY PRIMARY CARE, LLC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 1435 LELA ST
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City | FRANKLIN
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State | LA
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Zip | 70538-3127
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Country | US
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Telephone | 337-828-3090
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Fax | 337-828-3095
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Provider Business Mailing Address
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Address Line | 1435 LELA ST
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City | FRANKLIN
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State | LA
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Zip | 70538-3127
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Country | US
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Telephone | 337-828-3090
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Fax | 337-828-3095
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. KEIDRA ALBERTINE WELCH-SPENCER
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Credential | M.D.
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Telephone | 337-828-3090
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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 |
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License Number State |
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