Provider Demographics
NPI:1922156777
Name:FAMILY CLINIC OF DOCTORS' HOSPITAL
Entity Type:Organization
Organization Name:FAMILY CLINIC OF DOCTORS' HOSPITAL
Other - Org Name:FAMILY PHYSICIAN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MAIRUS
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-861-1144
Mailing Address - Street 1:MCFARLAND FAMILY CLINIC
Mailing Address - Street 2:3331 YOUREE DRIVE
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105
Mailing Address - Country:US
Mailing Address - Phone:318-861-1144
Mailing Address - Fax:318-861-1143
Practice Address - Street 1:MCFARLAND FAMILY CLINIC
Practice Address - Street 2:3331 YOUREE DRIVE
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-861-1144
Practice Address - Fax:318-861-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1448311Medicaid