Provider Demographics
NPI:1316038441
Name:BIENVILLE PARISH
Entity Type:Organization
Organization Name:BIENVILLE PARISH
Other - Org Name:BIENVILLE FAMILY CLINIC-ARCADIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-263-7970
Mailing Address - Street 1:1175 PINE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARCADIA
Mailing Address - State:LA
Mailing Address - Zip Code:71001-3113
Mailing Address - Country:US
Mailing Address - Phone:318-263-7970
Mailing Address - Fax:318-263-2008
Practice Address - Street 1:1175 PINE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-3113
Practice Address - Country:US
Practice Address - Phone:318-263-7970
Practice Address - Fax:318-263-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA060261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1172774Medicaid
LA1168190Medicaid
LA1442950Medicaid
LA4H170Medicare ID - Type UnspecifiedWANDA OVITT, FNP-C
LA5CH05Medicare ID - Type UnspecifiedLORING BARWICK, JR.,D.O.
LAG54608Medicare UPIN
LA5CB68Medicare ID - Type UnspecifiedBIENVILLE F PART B
LA1168190Medicaid
LA193845Medicare Oscar/Certification