Provider Demographics
NPI:1467757682
Name:LOUISIANA MEDICAL CLINIC
Entity Type:Organization
Organization Name:LOUISIANA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SONNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-1969
Mailing Address - Street 1:10466 AIRLINE HWY STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4047
Mailing Address - Country:US
Mailing Address - Phone:225-292-1969
Mailing Address - Fax:225-292-1960
Practice Address - Street 1:10466 AIRLINE HWY STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4047
Practice Address - Country:US
Practice Address - Phone:225-292-1969
Practice Address - Fax:225-292-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty