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NPI Code Detail

MEDICARE: NEIL HALIM FAIRFIELD FAMILY CLINIC

MEDICARE: NEIL HALIM FAIRFIELD FAMILY CLINIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD 022628LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1437379903FOTHERLABCBS NUMBER
21689623548OTHERLAINDIVIDAL NPI#
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104025121
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEIL HALIM FAIRFIELD FAMILY CLINIC
Provider Business Mailing Address
First Line : 1860 FAIRFIELD AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-4431
Country : US
Telephone Number : 318-675-1313
Fax Number :
Provider Business Practice Location Address
First Line : 1860 FAIRFIELD AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-4431
Country : US
Telephone Number : 318-675-1313
Fax Number :
Authorized Official
Title or Position : DOCTOR
Name : NEIL HAILM
Credential : M.D.
Telephone Number : 318-675-1313
Provider Enumeration Date : 07/11/2007
Last Update Date : 01/03/2023

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1437408846 — CHERYL WILEY ADAIR FNP
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1225417942 — SHANNON KOVELESKIE
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1275075129 — NEIL HALIM FAIRFIELD FAMILY CLINIC
Practice Location Address:
1860 FAIRFIELD AVE
SHREVEPORT, LA
71101-4431
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Practice Fax:

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