Provider Demographics
NPI:1043374291
Name:LEMLO MEDICAL CORPORATION, APMC
Entity Type:Organization
Organization Name:LEMLO MEDICAL CORPORATION, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON-DOZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-382-1976
Mailing Address - Street 1:PO BOX 915
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71058-0915
Mailing Address - Country:US
Mailing Address - Phone:318-382-1976
Mailing Address - Fax:318-377-9869
Practice Address - Street 1:128 HOMER RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-2732
Practice Address - Country:US
Practice Address - Phone:318-382-1976
Practice Address - Fax:318-377-9869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12209R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1440671Medicaid
LA5Y758Medicare ID - Type Unspecified