Provider Demographics
NPI:1669490538
Name:FAMILY MEDICINE CENTER
Entity Type:Organization
Organization Name:FAMILY MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-473-4081
Mailing Address - Street 1:2108 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3944
Mailing Address - Country:US
Mailing Address - Phone:318-473-4081
Mailing Address - Fax:
Practice Address - Street 1:2108 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3944
Practice Address - Country:US
Practice Address - Phone:318-473-4081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty