Provider Demographics
NPI:1831370444
Name:RICHARD RATHBONE, M.D. - AMC
Entity type:Organization
Organization Name:RICHARD RATHBONE, M.D. - AMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:RATHBONE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:225-683-3377
Mailing Address - Street 1:PO BOX 8348
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722
Mailing Address - Country:US
Mailing Address - Phone:225-683-3377
Mailing Address - Fax:225-683-3370
Practice Address - Street 1:11323 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722
Practice Address - Country:US
Practice Address - Phone:225-683-3377
Practice Address - Fax:225-683-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1949167Medicaid
LA5C428Medicare PIN