Provider Demographics
NPI:1073985396
Name:THE GENERAL MEDICINE CLINIC, LLC
Entity Type:Organization
Organization Name:THE GENERAL MEDICINE CLINIC, LLC
Other - Org Name:THE GENERAL MEDICINE CLINIC, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOWE-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-602-6302
Mailing Address - Street 1:3608 KIRKMAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-3006
Mailing Address - Country:US
Mailing Address - Phone:337-602-6302
Mailing Address - Fax:
Practice Address - Street 1:3608 KIRKMAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-3006
Practice Address - Country:US
Practice Address - Phone:337-602-6302
Practice Address - Fax:337-594-0931
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE GENERAL MEDICINE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-26
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2406442Medicaid