Provider Demographics
NPI:1619043916
Name:WEST MONROE FAMILY CLINIC
Entity Type:Organization
Organization Name:WEST MONROE FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-651-7000
Mailing Address - Street 1:PO BOX 1260
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-1260
Mailing Address - Country:US
Mailing Address - Phone:318-651-7000
Mailing Address - Fax:318-651-7012
Practice Address - Street 1:1900 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4416
Practice Address - Country:US
Practice Address - Phone:318-651-7000
Practice Address - Fax:318-651-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD12942R261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1949469Medicaid
LA1949469Medicaid