Provider Demographics
NPI:1700978251
Name:M&M FAMILY CLINIC, INC.
Entity Type:Organization
Organization Name:M&M FAMILY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:337-439-4220
Mailing Address - Street 1:1432 FOURNET ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-2452
Mailing Address - Country:US
Mailing Address - Phone:337-439-4220
Mailing Address - Fax:337-439-6351
Practice Address - Street 1:1432 FOURNET ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-2452
Practice Address - Country:US
Practice Address - Phone:337-439-4220
Practice Address - Fax:337-439-6351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAR050908364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1106798Medicaid
LA1448681Medicaid
LAB61872Medicare UPIN
LA4B662C688Medicare ID - Type Unspecified
LA1106798Medicaid
LA5M527Medicare ID - Type Unspecified