1487050829 NPI number — LOUISIANA FAMILY PRACTITIONERS LLC

Table of content: DR. HEATHER WODIS P.H D (NPI 1811555063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487050829 NPI number — LOUISIANA FAMILY PRACTITIONERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA FAMILY PRACTITIONERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EVANGELINE FAMILY HEALTHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487050829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 JACK MILLER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLE PLATTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70586-5600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-363-5334
Provider Business Mailing Address Fax Number:
337-363-2624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 JACK MILLER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VILLE PLATTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-363-5334
Provider Business Practice Location Address Fax Number:
337-363-2624
Provider Enumeration Date:
11/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SIGLER
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
PM CONSULTANT
Authorized Official Telephone Number:
318-201-5321

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 2203783231 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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