Provider Demographics
NPI:1982685293
Name:FAMILY PRACTICE ASSOCIATES
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-6363
Mailing Address - Street 1:65 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-8428
Mailing Address - Country:US
Mailing Address - Phone:318-445-6363
Mailing Address - Fax:318-445-1663
Practice Address - Street 1:65 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-8428
Practice Address - Country:US
Practice Address - Phone:318-445-6363
Practice Address - Fax:318-445-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1440876Medicaid
LACK2896OtherRAILROAD MEDICARE
LA5C772Medicare PIN