| Southern Pines Family Medical Center | |
|
64629 Highway 41 Pearl River LA 70452-3611 | |
| (985) 863-7100 | |
| Not Available |
| Full Name | Southern Pines Family Medical Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 64629 Highway 41, Pearl River, Louisiana |
| Authorized Official Name and Position | Glenn Butt (MEMBER) |
| Authorized Official Contact | 9858637100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Pines Family Medical Center Po Box 1659 Pearl River LA 70452-1659 Ph: (985) 863-7100 | Southern Pines Family Medical Center 64629 Highway 41 Pearl River LA 70452-3611 Ph: (985) 863-7100 |
| NPI Number | 1245326149 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 06/08/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245326149 | NPI | - | NPPES |
| 1439959 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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