Provider Demographics
NPI:1467599530
Name:CENLA FAMILY MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:CENLA FAMILY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-776-9340
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:LECOMPTE
Mailing Address - State:LA
Mailing Address - Zip Code:71346-0399
Mailing Address - Country:US
Mailing Address - Phone:318-776-9340
Mailing Address - Fax:318-776-8889
Practice Address - Street 1:1610 WATER STREET
Practice Address - Street 2:
Practice Address - City:LECOMPTE
Practice Address - State:LA
Practice Address - Zip Code:71346
Practice Address - Country:US
Practice Address - Phone:318-776-9340
Practice Address - Fax:318-776-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441899Medicaid
LA1441899Medicaid