Provider Demographics
NPI:1841576436
Name:MULTIPRACTICE CLINIC, INC.
Entity Type:Organization
Organization Name:MULTIPRACTICE CLINIC, INC.
Other - Org Name:MULTIPRACTICE CLINIC, INC. LACOMBE SATELLITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF INFORMATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ESTENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-878-0066
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:70443-0130
Mailing Address - Country:US
Mailing Address - Phone:985-878-0066
Mailing Address - Fax:985-878-0969
Practice Address - Street 1:27403 HIGHWAY 190
Practice Address - Street 2:SUITE A
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-6401
Practice Address - Country:US
Practice Address - Phone:985-882-9644
Practice Address - Fax:985-882-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)