Provider Demographics
NPI:1124026919
Name:HAMILTON MEDICAL GROUP, APC
Entity Type:Organization
Organization Name:HAMILTON MEDICAL GROUP, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR, BOARD OF DIRECTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-988-8801
Mailing Address - Street 1:4809 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8800
Mailing Address - Country:US
Mailing Address - Phone:337-988-8801
Mailing Address - Fax:337-988-8805
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8800
Practice Address - Country:US
Practice Address - Phone:337-988-8801
Practice Address - Fax:337-988-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1113328Medicaid
LAC50403OtherPALMETTO GBA - RAILROAD M
LAC50403OtherPALMETTO GBA - RAILROAD M
LA1113328Medicaid