| NPI | 1467496190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE H SOTAK Director Of Managed Care 318-675-7737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 255) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 255) |
| 208000000X Pediatrics (Licence: LA 255) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 255) | |
| 208600000X Surgery (Licence: LA 255) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2009-02-05 |