Provider Demographics
NPI:1356377097
Name:WELSH FAMILY PRACTICE CLINIC
Entity type:Organization
Organization Name:WELSH FAMILY PRACTICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-734-4901
Mailing Address - Street 1:308 PALMER ST
Mailing Address - Street 2:P.O. BOX 605
Mailing Address - City:WELSH
Mailing Address - State:LA
Mailing Address - Zip Code:70591-4320
Mailing Address - Country:US
Mailing Address - Phone:337-734-4901
Mailing Address - Fax:337-734-4338
Practice Address - Street 1:308 PALMER ST
Practice Address - Street 2:
Practice Address - City:WELSH
Practice Address - State:LA
Practice Address - Zip Code:70591-4320
Practice Address - Country:US
Practice Address - Phone:337-734-4901
Practice Address - Fax:337-734-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444758Medicaid
AL=========OtherTAX ID#
LA5CE99Medicare ID - Type Unspecified