Provider Demographics
NPI:1851455406
Name:FAMILY PRACTICE CENTER OF EUNICE
Entity Type:Organization
Organization Name:FAMILY PRACTICE CENTER OF EUNICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:WOOD
Authorized Official - Last Name:MCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-550-0067
Mailing Address - Street 1:145 WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-8241
Mailing Address - Country:US
Mailing Address - Phone:337-550-0067
Mailing Address - Fax:337-550-0070
Practice Address - Street 1:450 MOOSA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3610
Practice Address - Country:US
Practice Address - Phone:337-550-0067
Practice Address - Fax:337-550-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1186228Medicaid
LAH37754Medicare UPIN
LA5C907Medicare ID - Type UnspecifiedMEDICARE ID NUMBER