Provider Demographics
NPI:1578285946
Name:FARLEY PRIMARY CARE
Entity Type:Organization
Organization Name:FARLEY PRIMARY CARE
Other - Org Name:FARLEY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:225-218-4992
Mailing Address - Street 1:3557 MONTERREY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-2918
Mailing Address - Country:US
Mailing Address - Phone:225-218-4992
Mailing Address - Fax:225-361-0862
Practice Address - Street 1:3557 MONTERREY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-2918
Practice Address - Country:US
Practice Address - Phone:225-218-4992
Practice Address - Fax:225-361-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2486543Medicaid