Provider Demographics
NPI:1831359447
Name:HEALTH CARE FIRST MEDICAL CLINIC, LLC.
Entity type:Organization
Organization Name:HEALTH CARE FIRST MEDICAL CLINIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KOURTNI
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINS-LUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:225-648-3433
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:GROSSE TETE
Mailing Address - State:LA
Mailing Address - Zip Code:70740-0149
Mailing Address - Country:US
Mailing Address - Phone:225-648-3433
Mailing Address - Fax:
Practice Address - Street 1:12521 SCHLAYER AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8950
Practice Address - Country:US
Practice Address - Phone:225-648-3433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1454702Medicaid