Basic Information
| Provider Information | |||||||||
| NPI: | 1578017554 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BUTLER-ABSHIRE MEDICAL CLINIC, APMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 926 FRANCES DR | ||||||||
| Address2: | |||||||||
| City: | HAYNESVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710386100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186240554 | ||||||||
| FaxNumber: | 3186243782 | ||||||||
| Practice Location | |||||||||
| Address1: | 926 FRANCES DR | ||||||||
| Address2: | |||||||||
| City: | HAYNESVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710386100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186240554 | ||||||||
| FaxNumber: | 3186243782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2016 | ||||||||
| LastUpdateDate: | 08/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | ABSHIRE | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | SEC/TREAS | ||||||||
| AuthorizedOfficialTelephone: | 3186240554 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP08913 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.