Provider Demographics
NPI:1265971147
Name:DR. K'S FAMILY MEDICINE
Entity type:Organization
Organization Name:DR. K'S FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-829-0294
Mailing Address - Street 1:2871 S. COLUMBIA ST
Mailing Address - Street 2:STE A
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2781 S COLUMBIA ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-7962
Practice Address - Country:US
Practice Address - Phone:229-869-0294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD206754OtherLSBME
1821355637Medicare NSC