Provider Demographics
NPI:1336523224
Name:VILLAGE RURAL HEALTH CLINIC LLC
Entity type:Organization
Organization Name:VILLAGE RURAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPIRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-647-5008
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:MER ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:71261-0429
Mailing Address - Country:US
Mailing Address - Phone:318-647-5008
Mailing Address - Fax:
Practice Address - Street 1:301 DAVENPORT AVENUE
Practice Address - Street 2:
Practice Address - City:MER ROUGE
Practice Address - State:LA
Practice Address - Zip Code:71261
Practice Address - Country:US
Practice Address - Phone:318-647-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1446629Medicare UPIN