Provider Demographics
NPI:1235486226
Name:CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Entity Type:Organization
Organization Name:CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Other - Org Name:CARESOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRONT OFFICE/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-650-2000
Mailing Address - Street 1:PO BOX 66156
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6156
Mailing Address - Country:US
Mailing Address - Phone:225-650-2000
Mailing Address - Fax:225-650-2099
Practice Address - Street 1:904 CATALPA STREET
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346
Practice Address - Country:US
Practice Address - Phone:225-264-6800
Practice Address - Fax:225-264-6630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-08
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2317733Medicaid
LA2317733Medicaid