Provider Demographics
NPI:1891392304
Name:CHAUDHRY CLINIC LLC
Entity Type:Organization
Organization Name:CHAUDHRY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIAZ
Authorized Official - Middle Name:MASUD
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-992-4133
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-1470
Mailing Address - Country:US
Mailing Address - Phone:318-992-4133
Mailing Address - Fax:
Practice Address - Street 1:11809 HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-3703
Practice Address - Country:US
Practice Address - Phone:318-992-4133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health