Provider Demographics
NPI:1174681647
Name:AVOYELLES ADULT CARE A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AVOYELLES ADULT CARE A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:O
Authorized Official - Last Name:CORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-253-8600
Mailing Address - Street 1:4239 HIGHWAY 1192
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-4771
Mailing Address - Country:US
Mailing Address - Phone:318-253-8600
Mailing Address - Fax:318-253-8654
Practice Address - Street 1:4239 HIGHWAY 1192
Practice Address - Street 2:SUITE 200
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2956
Practice Address - Country:US
Practice Address - Phone:318-253-8600
Practice Address - Fax:318-253-8654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023281261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1541729Medicaid
LAG74311Medicare UPIN
LA5A800Medicare ID - Type Unspecified
LA5DJ07Medicare PIN