Family Care Clinic | |
107 Lela St Mangham LA 71259-5063 | |
(318) 248-4100 | |
(318) 248-4103 |
Full Name | Family Care Clinic |
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Speciality | Clinic/Center |
Location | 107 Lela St, Mangham, Louisiana |
Authorized Official Name and Position | Terri Lynn Klick (OWNER) |
Authorized Official Contact | 3182484100 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Family Care Clinic 107 Lela St Mangham LA 71259-5063 Ph: (318) 248-4100 | Family Care Clinic 107 Lela St Mangham LA 71259-5063 Ph: (318) 248-4100 |
NPI Number | 1023399888 |
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Provider Enumeration Date | 09/06/2011 |
Last Update Date | 10/20/2011 |
Medicare PECOS PAC ID | 8729251244 |
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Medicare Enrollment ID | O20111028000357 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023399888 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | APO6543 (Louisiana) | Primary |
Provider Name | Terri L Klick |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1558649905 PECOS PAC ID: 1254503766 Enrollment ID: I20111005000538 |
Provider Name | Jeffrey O White |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033559174 PECOS PAC ID: 9133354178 Enrollment ID: I20131030000178 |
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