Provider Demographics
NPI:1760558647
Name:CARL J POCHE MD, APMC
Entity Type:Organization
Organization Name:CARL J POCHE MD, APMC
Other - Org Name:POCHE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:POCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-869-3493
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-0369
Mailing Address - Country:US
Mailing Address - Phone:225-869-3493
Mailing Address - Fax:225-869-9333
Practice Address - Street 1:2454 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071
Practice Address - Country:US
Practice Address - Phone:225-860-3493
Practice Address - Fax:225-869-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA7775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1940381Medicaid
LA57716Medicare ID - Type Unspecified