Provider Demographics
NPI:1093744146
Name:MEDICAL & SURGICAL CLINIC A MEDICAL
Entity Type:Organization
Organization Name:MEDICAL & SURGICAL CLINIC A MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-375-3239
Mailing Address - Street 1:1003 SOUTH SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-3200
Mailing Address - Country:US
Mailing Address - Phone:318-375-3239
Mailing Address - Fax:318-375-2755
Practice Address - Street 1:1003 SOUTH SPRUCE ST
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3200
Practice Address - Country:US
Practice Address - Phone:318-375-3239
Practice Address - Fax:318-375-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1942995Medicaid
LA1942995Medicaid
LA5B464Medicare PIN