Provider Demographics
NPI:1013546720
Name:COMMUNITY FAMILY MEDICAL CLINIC OF BUNKIE LLC
Entity Type:Organization
Organization Name:COMMUNITY FAMILY MEDICAL CLINIC OF BUNKIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-945-1366
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0067
Mailing Address - Country:US
Mailing Address - Phone:337-945-1366
Mailing Address - Fax:
Practice Address - Street 1:117 W MAGNOLIA ST STE 2
Practice Address - Street 2:
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322-1706
Practice Address - Country:US
Practice Address - Phone:318-346-2288
Practice Address - Fax:318-346-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-04
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty