Provider Demographics
NPI:1184179079
Name:FORESTER LYME TREATMENT CENTER
Entity Type:Organization
Organization Name:FORESTER LYME TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:BARTEL
Authorized Official - Last Name:FORESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-641-0865
Mailing Address - Street 1:2809 DONAHUE FERRY RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4513
Mailing Address - Country:US
Mailing Address - Phone:318-641-0865
Mailing Address - Fax:318-640-3290
Practice Address - Street 1:2809 DONAHUE FERRY RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4513
Practice Address - Country:US
Practice Address - Phone:318-641-0865
Practice Address - Fax:318-640-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD06029R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty