Provider Demographics
NPI:1649524257
Name:CARLOCK ENTERPRISES LLC
Entity type:Organization
Organization Name:CARLOCK ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:VANCE
Authorized Official - Last Name:CARLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:337-238-5180
Mailing Address - Street 1:1100 NOLAN TRACE
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446
Mailing Address - Country:US
Mailing Address - Phone:337-238-5180
Mailing Address - Fax:337-238-4840
Practice Address - Street 1:1100 NOLAN TRACE
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446
Practice Address - Country:US
Practice Address - Phone:337-238-5180
Practice Address - Fax:318-759-0828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARLOCK ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-05
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA363L00000X, 363LF0000X, 363LP2300X, 261QR1300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty