# DRY PRONG FAMILY CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dry Prong Family Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366928277
- **Authorized official:** BENJAMIN COLVIN FNP (OWNER)
- **Authorized official phone:** (318) 568-8298

## Contact information

- **Practice address:** 800 GROVE STREET, DRY PRONG, LA 71423
- **Practice address phone:** (318) 568-8298
- **Practice address fax:** (318) 568-8297
- **Mailing address:** PO BOX 37, MONTGOMERY, LA 71454-0037

## Taxonomy

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

## Other

- **Enumeration date:** 07/13/2018
- **Last updated:** 06/02/2020