Provider Demographics
NPI:1265656375
Name:MEDICAL RESOURCES & GUIDANCE
Entity Type:Organization
Organization Name:MEDICAL RESOURCES & GUIDANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-363-4999
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0568
Mailing Address - Country:US
Mailing Address - Phone:337-363-4999
Mailing Address - Fax:337-363-3702
Practice Address - Street 1:123 WILLIAMSBURG ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5719
Practice Address - Country:US
Practice Address - Phone:337-480-1118
Practice Address - Fax:337-480-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM 2334251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1546950Medicaid