Provider Demographics
NPI:1033175906
Name:FAMILY MEDICAL CLINIC OF HOMER, LA INC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CLINIC OF HOMER, LA INC
Other - Org Name:CLIFTON W. SALMON, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:WALES
Authorized Official - Last Name:SALMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-927-6777
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:104 MORRIS CIRCLE
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-0300
Mailing Address - Country:US
Mailing Address - Phone:318-927-6777
Mailing Address - Fax:318-927-6714
Practice Address - Street 1:104 MORRIS CIR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-2100
Practice Address - Country:US
Practice Address - Phone:318-927-6777
Practice Address - Fax:318-927-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1443620Medicaid
5CC12Medicare ID - Type Unspecified