Provider Demographics
NPI:1598715898
Name:CALHOUN FAMILY CARE CLINIC LLC
Entity Type:Organization
Organization Name:CALHOUN FAMILY CARE CLINIC LLC
Other - Org Name:DELTA FAMILY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZUBER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:318-644-2573
Mailing Address - Street 1:3101 CYPRESS ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5286
Mailing Address - Country:US
Mailing Address - Phone:318-644-2573
Mailing Address - Fax:318-644-7177
Practice Address - Street 1:3101 CYPRESS ST
Practice Address - Street 2:SUITE 9
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5286
Practice Address - Country:US
Practice Address - Phone:318-644-2573
Practice Address - Fax:318-644-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QH0100X261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CU83OtherMEDICARE PTAN