# NEW LIFE MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073848354
- **Authorized official:** MRS. MIRIAM SONG STACEY (OWNER)
- **Authorized official phone:** (985) 542-7392

## Contact information

- **Practice address:** 50057 HWY 51 NORTH, TICKFAW, LA 70466
- **Practice address phone:** (985) 542-7392
- **Practice address fax:** (985) 542-7393
- **Mailing address:** 50057 HWY 51 NORTH, TICKFAW, LA 70466
- **Mailing address phone:** (985) 542-7392
- **Mailing address fax:** (985) 542-7393

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | LA | Yes |

## Other

- **Enumeration date:** 10/05/2009
- **Last updated:** 10/05/2009