Provider Demographics
NPI:1508206020
Name:RURAL HEALTH CLINIC OF LOREAUVILLE LLC
Entity Type:Organization
Organization Name:RURAL HEALTH CLINIC OF LOREAUVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:337-229-8288
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:LOREAUVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70552-0278
Mailing Address - Country:US
Mailing Address - Phone:337-229-8288
Mailing Address - Fax:
Practice Address - Street 1:411 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:LOREAUVILLE
Practice Address - State:LA
Practice Address - Zip Code:70552
Practice Address - Country:US
Practice Address - Phone:337-229-8288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health