Provider Demographics
NPI:1417370909
Name:WEST OUACHITA FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:WEST OUACHITA FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-644-5838
Mailing Address - Street 1:3057 HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:LA
Mailing Address - Zip Code:71225-7907
Mailing Address - Country:US
Mailing Address - Phone:318-644-5838
Mailing Address - Fax:318-644-5836
Practice Address - Street 1:3057 HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:LA
Practice Address - Zip Code:71225-7907
Practice Address - Country:US
Practice Address - Phone:318-644-5838
Practice Address - Fax:318-644-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
LA2203783685261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty