Provider Demographics
NPI:1225692445
Name:MURPHY CLINIC, LLC
Entity Type:Organization
Organization Name:MURPHY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-900-2503
Mailing Address - Street 1:350 LAKEVIEW CT STE B
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7523
Mailing Address - Country:US
Mailing Address - Phone:985-200-1003
Mailing Address - Fax:
Practice Address - Street 1:350 LAKEVIEW CT STE B
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7523
Practice Address - Country:US
Practice Address - Phone:985-200-1003
Practice Address - Fax:844-803-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD.11755ROtherSTATE LICENSE NUMBER
LA1682217Medicaid