Provider Demographics
NPI:1881026870
Name:TOTAL FAMILY MEDICAL, LLC
Entity Type:Organization
Organization Name:TOTAL FAMILY MEDICAL, LLC
Other - Org Name:WOMENS HEALTH ASSOC OF AMITE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-542-2466
Mailing Address - Street 1:44354 HIGHWAY 445
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROBERT
Mailing Address - State:LA
Mailing Address - Zip Code:70455-1999
Mailing Address - Country:US
Mailing Address - Phone:985-542-2466
Mailing Address - Fax:985-542-2755
Practice Address - Street 1:44354 HIGHWAY 445
Practice Address - Street 2:SUITE D
Practice Address - City:ROBERT
Practice Address - State:LA
Practice Address - Zip Code:70455-1999
Practice Address - Country:US
Practice Address - Phone:985-542-2466
Practice Address - Fax:985-542-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty