Provider Demographics
NPI:1386066991
Name:FAMILY HEALTH MEDICAL BUILDING, LLC
Entity type:Organization
Organization Name:FAMILY HEALTH MEDICAL BUILDING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:225-665-5149
Mailing Address - Street 1:8369 FLORIDA BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-7862
Mailing Address - Country:US
Mailing Address - Phone:225-665-5149
Mailing Address - Fax:225-667-1770
Practice Address - Street 1:8369 FLORIDA BLVD
Practice Address - Street 2:STE 1
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7862
Practice Address - Country:US
Practice Address - Phone:225-665-5149
Practice Address - Fax:225-667-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1042153Medicaid
LA1042153Medicaid