Provider Demographics
NPI:1962428953
Name:FAMILY MEDICINE PHYSICIANS, L.L.C.
Entity type:Organization
Organization Name:FAMILY MEDICINE PHYSICIANS, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SMITTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-345-9606
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-0280
Mailing Address - Country:US
Mailing Address - Phone:985-345-9606
Mailing Address - Fax:
Practice Address - Street 1:16052 DOCTOR'S BOULEVARD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-386-6584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1949531Medicaid
LADA4862OtherRAILROAD MEDICARE
LA5CG09Medicare ID - Type Unspecified