Provider Demographics
NPI:1114292679
Name:COMPANY CLINIC OF LOUISIANA, LLC
Entity Type:Organization
Organization Name:COMPANY CLINIC OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-741-5858
Mailing Address - Street 1:PO BOX 5257
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71171-5257
Mailing Address - Country:US
Mailing Address - Phone:318-741-5858
Mailing Address - Fax:318-946-8767
Practice Address - Street 1:5015 SHED RD
Practice Address - Street 2:SUITE 500
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5584
Practice Address - Country:US
Practice Address - Phone:318-741-5858
Practice Address - Fax:318-741-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine