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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
1261QP2300XPrimary Care Clinic/CenterAP08906LA

General Provider Information

NPI Number : 1275075129
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEIL HALIM FAIRFIELD FAMILY CLINIC
Provider Business Mailing Address
First Line : 314 BLUE FOX CIR
Second Line :
City : HAUGHTON
State : LA
Zip : 71037-7707
Country : US
Telephone Number :
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 : OFFICE MANAGER
Name : CINDER PUCKETT
Credential :
Telephone Number : 318-675-1313
Provider Enumeration Date : 11/09/2016
Last Update Date : 11/09/2016

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Directions to “NEIL HALIM FAIRFIELD FAMILY CLINIC ” Practice Location

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