Provider Demographics
NPI:1083814453
Name:FAMILY HEALTH CLINIC
Entity Type:Organization
Organization Name:FAMILY HEALTH CLINIC
Other - Org Name:HAYES MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-237-7712
Mailing Address - Street 1:715 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2309
Mailing Address - Country:US
Mailing Address - Phone:337-237-7712
Mailing Address - Fax:337-232-0313
Practice Address - Street 1:715 COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2309
Practice Address - Country:US
Practice Address - Phone:337-237-7712
Practice Address - Fax:337-232-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018225174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1901687Medicaid
LA1901687Medicaid
LAE20787Medicare UPIN