Provider Demographics
NPI:1972761641
Name:RANDALL COY DUPLECHAIN, M.D.,APMC
Entity Type:Organization
Organization Name:RANDALL COY DUPLECHAIN, M.D.,APMC
Other - Org Name:THE FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUPLECHAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-462-1080
Mailing Address - Street 1:701 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4943
Mailing Address - Country:US
Mailing Address - Phone:337-462-1080
Mailing Address - Fax:337-462-5346
Practice Address - Street 1:701 S PINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4943
Practice Address - Country:US
Practice Address - Phone:337-462-1080
Practice Address - Fax:337-462-5346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16185261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1337404Medicaid
LA1337404Medicaid