Basic Information
| Provider Information | |||||||||
| NPI: | 1881026870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOTAL FAMILY MEDICAL, LLC | ||||||||
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| OtherOrganizationName: | WOMENS HEALTH ASSOC OF AMITE | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44354 HIGHWAY 445 | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ROBERT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704551999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9855422466 | ||||||||
| FaxNumber: | 9855422755 | ||||||||
| Practice Location | |||||||||
| Address1: | 44354 HIGHWAY 445 | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ROBERT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704551999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9855422466 | ||||||||
| FaxNumber: | 9855422755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2013 | ||||||||
| LastUpdateDate: | 02/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | GAUTREAU | ||||||||
| AuthorizedOfficialFirstName: | PEGGY | ||||||||
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| AuthorizedOfficialTitleorPosition: | RN | ||||||||
| AuthorizedOfficialTelephone: | 9855422466 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.