Provider Demographics
NPI:1811126550
Name:FCC OAKDALE
Entity type:Organization
Organization Name:FCC OAKDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVADORE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-335-4466
Mailing Address - Street 1:PO BOX 5050
Mailing Address - Street 2:5050 EAST WHATLEY ROAD
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-5050
Mailing Address - Country:US
Mailing Address - Phone:318-335-4466
Mailing Address - Fax:318-215-2135
Practice Address - Street 1:5050 EAST WHATLEY ROAD
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-5050
Practice Address - Country:US
Practice Address - Phone:318-335-4466
Practice Address - Fax:318-215-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80985261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health