Provider Demographics
NPI:1518570688
Name:DELTA MED CLINIC LLC
Entity type:Organization
Organization Name:DELTA MED CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:318-403-6080
Mailing Address - Street 1:1305 FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71343-2123
Mailing Address - Country:US
Mailing Address - Phone:318-403-6080
Mailing Address - Fax:318-403-6087
Practice Address - Street 1:1305 FOURTH ST STE A
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71343-2123
Practice Address - Country:US
Practice Address - Phone:318-403-6053
Practice Address - Fax:318-403-6087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2346971Medicaid