Provider Demographics
NPI:1215067905
Name:GOUX FAMILY MEDICINE CTR LLC
Entity type:Organization
Organization Name:GOUX FAMILY MEDICINE CTR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GOUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-253-7511
Mailing Address - Street 1:4239 HIGHWAY 1192
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-4711
Mailing Address - Country:US
Mailing Address - Phone:318-253-7511
Mailing Address - Fax:318-253-7513
Practice Address - Street 1:4239 HIGHWAY 1192
Practice Address - Street 2:SUITE 100
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-4711
Practice Address - Country:US
Practice Address - Phone:318-253-7511
Practice Address - Fax:318-253-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD201185261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1454036Medicaid
LA1454036Medicaid