# FAMILY MEDICAL CENTER

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

## Provider details

- **NPI number:** 1225029515
- **Authorized official:** GREG J. GAVIN (NETWORK ADMINISTRATOR)
- **Authorized official phone:** (318) 212-4571

## Contact information

- **Practice address:** 8001 YOUREE DR, SUITE 900, SHREVEPORT, LA 71115-2302
- **Practice address phone:** (318) 212-3830
- **Practice address fax:** (318) 212-3835
- **Mailing address:** 7813 YOUREE DR, SHREVEPORT, LA 71105-5505
- **Mailing address phone:** (318) 212-3830
- **Mailing address fax:** (318) 212-3835

## Taxonomy

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

## Other

- **Enumeration date:** 11/04/2005
- **Last updated:** 06/08/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1797031 | — | LA |