Provider Demographics
NPI:1316647043
Name:GOT YOUR SIX MEDICAL GROUP LLC
Entity type:Organization
Organization Name:GOT YOUR SIX MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:318-229-8703
Mailing Address - Street 1:154 SHADOW RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEY
Mailing Address - State:LA
Mailing Address - Zip Code:71407-2824
Mailing Address - Country:US
Mailing Address - Phone:318-229-8703
Mailing Address - Fax:
Practice Address - Street 1:154 SHADOW RD
Practice Address - Street 2:
Practice Address - City:BENTLEY
Practice Address - State:LA
Practice Address - Zip Code:71407-2824
Practice Address - Country:US
Practice Address - Phone:318-229-8703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty