Provider Demographics
NPI:1598949729
Name:LASALLE FAMILY MEDICINE
Entity Type:Organization
Organization Name:LASALLE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-992-9200
Mailing Address - Street 1:PO BOX 2780
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-2780
Mailing Address - Country:US
Mailing Address - Phone:318-992-9296
Mailing Address - Fax:318-992-9125
Practice Address - Street 1:180 NINTH STREET
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342
Practice Address - Country:US
Practice Address - Phone:318-992-9296
Practice Address - Fax:318-992-9125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LASALLE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-24
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center