Provider Demographics
NPI:1689871196
Name:COMPLETE FAMILY CARE OF AVOYELLES
Entity Type:Organization
Organization Name:COMPLETE FAMILY CARE OF AVOYELLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:GUILLOT
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-356-6011
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-1140
Mailing Address - Country:US
Mailing Address - Phone:318-240-1959
Mailing Address - Fax:318-240-1960
Practice Address - Street 1:4218 HIGHWAY 1192
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-4710
Practice Address - Country:US
Practice Address - Phone:318-240-1959
Practice Address - Fax:318-240-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200235261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CY87Medicare PIN