Provider Demographics
NPI:1679772347
Name:STAT FAMILY CARE OF JENNINGS, LLC
Entity Type:Organization
Organization Name:STAT FAMILY CARE OF JENNINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-616-9948
Mailing Address - Street 1:1615 JOHNSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3650
Mailing Address - Country:US
Mailing Address - Phone:337-616-9945
Mailing Address - Fax:337-616-9946
Practice Address - Street 1:1615 JOHNSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3650
Practice Address - Country:US
Practice Address - Phone:337-616-9945
Practice Address - Fax:337-616-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08095R305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization