Basic Information
| Provider Information | |||||||||
| NPI: | 1801010426 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODLAWN FAMILY HEALTH, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WOODLAWN FAMILY HEALTH LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5428 STUMBERG LN | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257564100 | ||||||||
| FaxNumber: | 2257564106 | ||||||||
| Practice Location | |||||||||
| Address1: | 5428 STUMBERG LN | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257564100 | ||||||||
| FaxNumber: | 2257564106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 03/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | DAIGLE | ||||||||
| AuthorizedOfficialFirstName: | RENEE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER OF CLINIC | ||||||||
| AuthorizedOfficialTelephone: | 2257564100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WOODLAWN FAMILY HEALTH LLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.