Provider Demographics
NPI:1558791905
Name:TOTAL FAMILY MEDICAL, LLC
Entity Type:Organization
Organization Name:TOTAL FAMILY MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-542-2466
Mailing Address - Street 1:PO BOX 14149
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-4149
Mailing Address - Country:US
Mailing Address - Phone:225-930-0060
Mailing Address - Fax:225-952-9075
Practice Address - Street 1:44354 HIGHWAY 445 STE D
Practice Address - Street 2:
Practice Address - City:ROBERT
Practice Address - State:LA
Practice Address - Zip Code:70455-1999
Practice Address - Country:US
Practice Address - Phone:985-542-2466
Practice Address - Fax:985-542-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health