Provider Demographics
NPI:1225499361
Name:CANE RIVER FAMILY MEDICINE A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CANE RIVER FAMILY MEDICINE A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:LUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-402-1483
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457
Mailing Address - Country:US
Mailing Address - Phone:318-238-6401
Mailing Address - Fax:
Practice Address - Street 1:617 BIENVILLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457
Practice Address - Country:US
Practice Address - Phone:318-238-6401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty