Provider Demographics
NPI:1407385958
Name:CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED
Entity Type:Organization
Organization Name:CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MAIMOUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITA
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 1:4852 HIGHWAY 19 STE A
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3530
Practice Address - Country:US
Practice Address - Phone:225-654-7000
Practice Address - Fax:225-654-7067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-08
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)