Provider Demographics
NPI:1801210133
Name:CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Entity Type:Organization
Organization Name:CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Other - Org Name:CARESOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMA, CPC, RMC
Authorized Official - Phone:225-650-2028
Mailing Address - Street 1:PO BOX 66156
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6156
Mailing Address - Country:US
Mailing Address - Phone:225-650-2000
Mailing Address - Fax:225-615-8212
Practice Address - Street 1:59340 RIVER WEST DR
Practice Address - Street 2:SUITE A & B
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6553
Practice Address - Country:US
Practice Address - Phone:225-385-4742
Practice Address - Fax:225-385-4279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITOL CITY FAMILY HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-06
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2356631Medicaid
LA191943Medicare PIN