Provider Demographics
NPI:1881931152
Name:SLAINTE FAMILY CLINIC LLC
Entity type:Organization
Organization Name:SLAINTE FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:WEAVER
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-C
Authorized Official - Phone:318-518-8329
Mailing Address - Street 1:121 GATES DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-4119
Mailing Address - Country:US
Mailing Address - Phone:318-518-8329
Mailing Address - Fax:
Practice Address - Street 1:188 BURT BLVD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-4900
Practice Address - Country:US
Practice Address - Phone:318-965-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1013264878OtherNPI
LA2345419Medicaid
LA1013264878OtherNPI