Provider Demographics
NPI:1912092438
Name:LOUISA FAMILY PRACTICE, PLC
Entity Type:Organization
Organization Name:LOUISA FAMILY PRACTICE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-967-2202
Mailing Address - Street 1:101 WOOLFOLK AVENUE
Mailing Address - Street 2:P.O. BOX 1367
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093
Mailing Address - Country:US
Mailing Address - Phone:540-967-2202
Mailing Address - Fax:540-967-1676
Practice Address - Street 1:101 WOOLFOLK AVENUE
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093
Practice Address - Country:US
Practice Address - Phone:540-967-2202
Practice Address - Fax:540-967-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care