Provider Demographics
NPI:1508186172
Name:LUTCHER FAMILY CLINIC
Entity Type:Organization
Organization Name:LUTCHER FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CULLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OCMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-869-9890
Mailing Address - Street 1:1731 LUTCHER AVE
Mailing Address - Street 2:
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-0000
Mailing Address - Country:US
Mailing Address - Phone:225-869-9890
Mailing Address - Fax:225-869-3822
Practice Address - Street 1:1731 LUTCHER AVE
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-0000
Practice Address - Country:US
Practice Address - Phone:225-869-9890
Practice Address - Fax:225-869-3822
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JAMES PARISH HOSP SERV DIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-07
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1072940Medicaid
LA1053588467OtherDR'S NPI
LA1053588467OtherDR'S NPI