MEDICARE: WEST OUACHITA FAMILY MEDICINE LLC

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
1	261Q00000X	Clinic/Center
2	261QR1300X	Rural Health Clinic/Center	2203783685	LA

General Provider Information

NPI Number	:	1417370909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST OUACHITA FAMILY MEDICINE LLC

Provider Business Mailing Address
First Line	:	3057 HIGHWAY 80 W
Second Line	:
City	:	CALHOUN
State	:	LA
Zip	:	71225-7907
Country	:	US
Telephone Number	:	318-644-5838
Fax Number	:	318-644-5836

Provider Business Practice Location Address
First Line	:	3057 HIGHWAY 80 W
Second Line	:
City	:	CALHOUN
State	:	LA
Zip	:	71225-7907
Country	:	US
Telephone Number	:	318-644-5838
Fax Number	:	318-644-5836

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALAN RAY HANCOCK
Credential	:
Telephone Number	:	318-644-5838

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	11/15/2022

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