Provider Demographics
NPI:1366527665
Name:FAMILY DOCTOR CLINIC DRS HARRIS & MAGEE A MEDICAL CORPORATION
Entity type:Organization
Organization Name:FAMILY DOCTOR CLINIC DRS HARRIS & MAGEE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:985-446-2680
Mailing Address - Street 1:804 SOUTH ACADIA ROAD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301
Mailing Address - Country:US
Mailing Address - Phone:985-446-2680
Mailing Address - Fax:985-447-2528
Practice Address - Street 1:804 SOUTH ACADIA ROAD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-446-2680
Practice Address - Fax:985-447-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACP7384OtherRAILROAD MEDICARE
LA1799751Medicaid
LA1799751Medicaid
LA0290120001Medicare NSC