Basic Information
| Provider Information | |||||||||
| NPI: | 1891161386 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOTAL FAMILY MEDICAL, LLC | ||||||||
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| OtherOrganizationName: | TOTAL FAMILY MEDICAL OF LORANGER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44354 HIGHWAY 445 STE D | ||||||||
| Address2: | |||||||||
| City: | ROBERT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704551999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9855422466 | ||||||||
| FaxNumber: | 9855422755 | ||||||||
| Practice Location | |||||||||
| Address1: | 54002 HIGHWAY 1062 | ||||||||
| Address2: | |||||||||
| City: | LORANGER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704463538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042365311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2015 | ||||||||
| LastUpdateDate: | 08/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | GAUTREAU | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5042365311 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TOTAL FAMILY MEDICAL, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | LA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.