MEDICARE: BYRDWORTH MEDICAL 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	207Q00000X	Family Medicine Physician	024152	LA

General Provider Information

NPI Number	:	1538563069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BYRDWORTH MEDICAL LLC

Provider Business Mailing Address
First Line	:	3645 S BEGLIS PKWY
Second Line	:	SUITE C
City	:	SULPHUR
State	:	LA
Zip	:	70665-8107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3645 S BEGLIS PKWY
Second Line	:	SUITE C
City	:	SULPHUR
State	:	LA
Zip	:	70665-8107
Country	:	US
Telephone Number	:	337-446-2928
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	STACY BYRD
Credential	:
Telephone Number	:	337-446-2928

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	10/13/2014

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Directions to “BYRDWORTH MEDICAL LLC ” Practice Location

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