Provider Demographics
NPI:1093996969
Name:RICHARDSON MEDICAL CENTER SCHOOL BASED HEALTH CLINIC
Entity Type:Organization
Organization Name:RICHARDSON MEDICAL CENTER SCHOOL BASED HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-728-4181
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-0388
Mailing Address - Country:US
Mailing Address - Phone:318-728-4181
Mailing Address - Fax:318-728-8287
Practice Address - Street 1:155 HWY 3048
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269
Practice Address - Country:US
Practice Address - Phone:318-728-4181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHLAND HOSPITAL SERVICE DISCTICT #1-B
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-20
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health