Provider Demographics
NPI:1609065275
Name:RANKIN FAMILY MEDICINE
Entity Type:Organization
Organization Name:RANKIN FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-213-1030
Mailing Address - Street 1:PO BOX 6795
Mailing Address - Street 2:RANKIN FAMILY MEDICINE
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71136-6795
Mailing Address - Country:US
Mailing Address - Phone:318-213-1030
Mailing Address - Fax:318-213-1031
Practice Address - Street 1:725 NORTH ASHLEY RIDGE LOOP
Practice Address - Street 2:RANKIN FAMILY MEDICINE, SUITE #400
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106
Practice Address - Country:US
Practice Address - Phone:318-213-1030
Practice Address - Fax:318-213-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2119753Medicaid
LA5BD16Medicare PIN