Provider Demographics
NPI:1962675272
Name:FAMILY MEDICINE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYELLON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-702-1220
Mailing Address - Street 1:6322 HIGHWAY 182 E
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-2038
Mailing Address - Country:US
Mailing Address - Phone:985-702-1220
Mailing Address - Fax:985-702-9715
Practice Address - Street 1:6322 HIGHWAY 182 E STE 200
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-2038
Practice Address - Country:US
Practice Address - Phone:985-702-1220
Practice Address - Fax:985-702-9715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15521R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1464368Medicaid
LA5405870060OtherBLU E CROSS BLUE SHIELD
LADC6205OtherMEDICARE RAILROAD
LAI21838Medicare UPIN
LADC6205OtherMEDICARE RAILROAD