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402 N Vaughan St Brusly LA 70719-2225 | |
(225) 749-2645 | |
(225) 749-8216 |
Full Name | |
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Speciality | Family Medicine |
Location | 402 N Vaughan St, Brusly, Louisiana |
Authorized Official Name and Position | Brian P Higgins (PRESIDENT) |
Authorized Official Contact | 2257492645 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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402 N Vaughan St Brusly LA 70719-2225 Ph: (225) 749-2645 | 402 N Vaughan St Brusly LA 70719-2225 Ph: (225) 749-2645 |
NPI Number | 1043316631 |
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Provider Enumeration Date | 09/15/2006 |
Last Update Date | 07/16/2007 |
Identifier | Type | State | Issuer |
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1043316631 | NPI | - | NPPES |
1446777 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 024237 (Louisiana) | Primary |