# DESOTO REGIONAL FAMILY MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DeSoto Regional Family Medicine - Mansfield
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043359839
- **Authorized official:** HALLIE DEUTSCH (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (318) 871-3101

## Contact information

- **Practice address:** 130 JEFFERSON ST, MANSFIELD, LA 71052-2602
- **Practice address phone:** (318) 872-2700
- **Practice address fax:** (318) 872-6214
- **Mailing address:** 130 JEFFERSON ST, MANSFIELD, LA 71052-2602
- **Mailing address phone:** (318) 872-2700
- **Mailing address fax:** (318) 872-6214

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | LA | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/06/2007
- **Last updated:** 03/27/2023