Provider Demographics
NPI:1811136682
Name:CHAUDHRY CLINIC LLC
Entity type:Organization
Organization Name:CHAUDHRY CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIAZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-992-4133
Mailing Address - Street 1:P.O.BOX 1470
Mailing Address - Street 2:11809 HWY. 84 W.
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342
Mailing Address - Country:US
Mailing Address - Phone:318-992-4133
Mailing Address - Fax:318-992-4134
Practice Address - Street 1:11809 HWY 84 W.
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342
Practice Address - Country:US
Practice Address - Phone:318-992-4133
Practice Address - Fax:318-992-4134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAUDHRY CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-18
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3939R261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1306882568Medicare NSC