Provider Demographics
NPI:1700844081
Name:RICHLAND MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RICHLAND MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:P
Authorized Official - Last Name:FOLSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-878-3367
Mailing Address - Street 1:PO BOX 1020
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-1020
Mailing Address - Country:US
Mailing Address - Phone:318-878-3367
Mailing Address - Fax:318-878-8638
Practice Address - Street 1:254 HIGHWAY 3048
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3624
Practice Address - Country:US
Practice Address - Phone:318-878-3367
Practice Address - Fax:318-878-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1797944Medicaid
LA1797944Medicaid
56970Medicare ID - Type Unspecified