Provider Demographics
NPI:1891920708
Name:ST ROY FAMILY CARE LLC
Entity Type:Organization
Organization Name:ST ROY FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:STROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-769-1095
Mailing Address - Street 1:PO BOX 91133
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-1133
Mailing Address - Country:US
Mailing Address - Phone:337-769-1095
Mailing Address - Fax:337-769-1098
Practice Address - Street 1:1002 12TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6224
Practice Address - Country:US
Practice Address - Phone:337-769-1095
Practice Address - Fax:337-769-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13348R207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1561797Medicaid