Provider Demographics
NPI:1316266943
Name:LOUISIANA FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:LOUISIANA FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-441-8309
Mailing Address - Street 1:6314 BAYOU CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-7028
Mailing Address - Country:US
Mailing Address - Phone:337-258-7178
Mailing Address - Fax:318-441-8309
Practice Address - Street 1:504 JACK MILLER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5600
Practice Address - Country:US
Practice Address - Phone:337-363-8991
Practice Address - Fax:337-363-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAGETP.200094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1099619Medicaid