| Family Medicine Center | |
|
540 Durham Street Bastrop LA 71220 | |
| (318) 283-2200 | |
| (318) 283-1200 |
| Full Name | Family Medicine Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 540 Durham Street, Bastrop, Louisiana |
| Authorized Official Name and Position | M. Tahir Qayyum (OWNER) |
| Authorized Official Contact | 3182832200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine Center 540 Durham St Bastrop LA 71220-5013 Ph: (318) 283-2200 | Family Medicine Center 540 Durham Street Bastrop LA 71220 Ph: (318) 283-2200 |
| NPI Number | 1487821708 |
|---|---|
| Provider Enumeration Date | 05/15/2008 |
| Last Update Date | 10/22/2010 |
| Medicare PECOS PAC ID | 1153381827 |
|---|---|
| Medicare Enrollment ID | O20101021001033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487821708 | NPI | - | NPPES |
| 1447111 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 10850R (Louisiana) | Primary |
| Provider Name | Tahir Qayyum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083714117 PECOS PAC ID: 1557274834 Enrollment ID: I20101026000919 |
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