Provider Demographics
NPI:1790952893
Name:RAYMOND F. SCHNEIDER MEMORIAL CLINIC, LLC
Entity Type:Organization
Organization Name:RAYMOND F. SCHNEIDER MEMORIAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-229-7929
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:1302 ED BROUSSARD ROAD
Mailing Address - City:LOREAUVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70552
Mailing Address - Country:US
Mailing Address - Phone:337-229-7929
Mailing Address - Fax:
Practice Address - Street 1:1302 ED BROUSSARD ROAD
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563
Practice Address - Country:US
Practice Address - Phone:337-229-7929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA129261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1037591Medicaid
LA193886Medicare Oscar/Certification