Provider Demographics
NPI:1992868327
Name:FAMILY FIRST MEDICINE, APMC
Entity Type:Organization
Organization Name:FAMILY FIRST MEDICINE, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-513-1950
Mailing Address - Street 1:PO BOX 2034
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-2034
Mailing Address - Country:US
Mailing Address - Phone:318-513-1950
Mailing Address - Fax:
Practice Address - Street 1:902 S VIENNA ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5830
Practice Address - Country:US
Practice Address - Phone:318-513-1950
Practice Address - Fax:318-513-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1448541Medicaid
LA1448541Medicaid
LAE71025Medicare UPIN
LA193864Medicare Oscar/Certification