Provider Demographics
NPI:1184615726
Name:MULTIPRACTICE CLINIC
Entity type:Organization
Organization Name:MULTIPRACTICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARPLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-878-0066
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:70443-0130
Mailing Address - Country:US
Mailing Address - Phone:985-878-0066
Mailing Address - Fax:985-878-0969
Practice Address - Street 1:281 W 4TH ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-2386
Practice Address - Country:US
Practice Address - Phone:985-878-0066
Practice Address - Fax:985-878-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1448109Medicaid
LA191849OtherMEDICARE NGS