| The Family Care Center Of Southwest Louisiana, Llc | |
|
2345 Sampson St Westlake LA 70669-2711 | |
| (337) 439-1484 | |
| (337) 430-0927 |
| Full Name | The Family Care Center Of Southwest Louisiana, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2345 Sampson St, Westlake, Louisiana |
| Authorized Official Name and Position | Jody George (OWNER) |
| Authorized Official Contact | 3374391484 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Family Care Center Of Southwest Louisiana, Llc 2345 Sampson St Westlake LA 70669-2711 Ph: (337) 439-1484 | The Family Care Center Of Southwest Louisiana, Llc 2345 Sampson St Westlake LA 70669-2711 Ph: (337) 439-1484 |
| NPI Number | 1467675462 |
|---|---|
| Provider Enumeration Date | 04/10/2007 |
| Last Update Date | 01/10/2008 |
| Medicare PECOS PAC ID | 1456445055 |
|---|---|
| Medicare Enrollment ID | O20070913000094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467675462 | NPI | - | NPPES |
| 1021571 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jody George |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568592368 PECOS PAC ID: 2163516766 Enrollment ID: I20071031000114 |
| Provider Name | Ramona Leigh Whittington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609191113 PECOS PAC ID: 6608909924 Enrollment ID: I20100805001148 |
Randall K Wagman Md Apmc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2345 Sampson St, Westlake, LA 70669 Phone: 337-439-1484 Fax: 337-430-0927 |