Provider Demographics
NPI:1689782286
Name:THE FAMILY CLINIC OF CROWLEY, INC
Entity Type:Organization
Organization Name:THE FAMILY CLINIC OF CROWLEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:POUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-783-7004
Mailing Address - Street 1:345 ODD FELLOWS RD
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-2206
Mailing Address - Country:US
Mailing Address - Phone:337-783-7004
Mailing Address - Fax:337-783-0070
Practice Address - Street 1:345 ODD FELLOWS RD
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526
Practice Address - Country:US
Practice Address - Phone:337-783-7004
Practice Address - Fax:337-783-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022382/022292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1949833Medicaid
LAC18492OtherMEDICARE RAILROAD PALMETT
LA1949833Medicaid