Provider Demographics
NPI:1104025121
Name:NEIL HALIM FAIRFIELD FAMILY CLINIC
Entity Type:Organization
Organization Name:NEIL HALIM FAIRFIELD FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-675-1313
Mailing Address - Street 1:1860 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4431
Mailing Address - Country:US
Mailing Address - Phone:318-675-1313
Mailing Address - Fax:
Practice Address - Street 1:1860 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4431
Practice Address - Country:US
Practice Address - Phone:318-675-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 022628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA437379903FOtherBCBS NUMBER
LA1689623548OtherINDIVIDAL NPI#
LA1681831Medicaid
LAG28771Medicare UPIN
LA5CR63Medicare PIN
LA1689623548OtherINDIVIDAL NPI#