Provider Demographics
NPI:1417671900
Name:BYRD MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:BYRD MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-239-5114
Mailing Address - Street 1:1020 W FERTITTA BLVD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4645
Mailing Address - Country:US
Mailing Address - Phone:337-239-5114
Mailing Address - Fax:
Practice Address - Street 1:1020 W FERTITTA BLVD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4645
Practice Address - Country:US
Practice Address - Phone:337-239-9041
Practice Address - Fax:337-239-5360
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BYRD MEDICAL CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty