Provider Demographics
NPI:1215625892
Name:JONESVILLE FAMILY HEALTHCARE
Entity type:Organization
Organization Name:JONESVILLE FAMILY HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:COTTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-324-0475
Mailing Address - Street 1:PO BOX 3843
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71361-3843
Mailing Address - Country:US
Mailing Address - Phone:318-403-3788
Mailing Address - Fax:318-987-8300
Practice Address - Street 1:800 AUDUBON DR
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71343-2432
Practice Address - Country:US
Practice Address - Phone:318-657-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2523953Medicaid