MEDICARE: FAMILY MEDICINE CENTER

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

General Provider Information

NPI Number	:	1669490538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE CENTER

Provider Business Mailing Address
First Line	:	2108 TEXAS AVE
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3944
Country	:	US
Telephone Number	:	318-473-4081
Fax Number	:

Provider Business Practice Location Address
First Line	:	2108 TEXAS AVE
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3944
Country	:	US
Telephone Number	:	318-473-4081
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. JACKIE BAILLY
Credential	:
Telephone Number	:	318-473-4081

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/22/2020

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Directions to “FAMILY MEDICINE CENTER ” Practice Location

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