Provider Demographics
NPI:1659816858
Name:VELOCITY MD LLC
Entity Type:Organization
Organization Name:VELOCITY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OVERSIGHT & MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-629-3763
Mailing Address - Street 1:307 KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5801
Mailing Address - Country:US
Mailing Address - Phone:318-352-5221
Mailing Address - Fax:318-352-7757
Practice Address - Street 1:307 KEYSER AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5801
Practice Address - Country:US
Practice Address - Phone:318-352-5221
Practice Address - Fax:318-352-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.019455261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center