MEDICARE: ELLENDER FAMILY MEDICINE, APMC

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	024917	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558485235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLENDER FAMILY MEDICINE, APMC

Provider Business Mailing Address
First Line	:	2967 S UNION ST
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-5740
Country	:	US
Telephone Number	:	337-594-8958
Fax Number	:	337-594-8987

Provider Business Practice Location Address
First Line	:	2967 S UNION ST
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-5740
Country	:	US
Telephone Number	:	337-594-8958
Fax Number	:	337-594-8987

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEE DARRELL ELLENDER
Credential	:	M.D.
Telephone Number	:	337-594-8958

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	03/13/2017

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