Provider Demographics
NPI:1366672016
Name:RAYVILLE FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:RAYVILLE FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:SYLVESTRI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:318-728-8833
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-0658
Mailing Address - Country:US
Mailing Address - Phone:318-728-8833
Mailing Address - Fax:318-728-8940
Practice Address - Street 1:1962 JULIA ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-5527
Practice Address - Country:US
Practice Address - Phone:318-728-8833
Practice Address - Fax:318-728-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X, 363LF0000X
LA157261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1808440Medicaid
LA1808440Medicaid
LA193900Medicare PIN