# SOUTH LOUISIANA PRIMARY CARE LLC

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

## Provider details

- **NPI number:** 1447705074
- **Authorized official:** DUSTIN ALLEN LOGUE ANP (OWNER)
- **Authorized official phone:** (225) 774-0733

## Contact information

- **Practice address:** 12902 PLANK RD, BAKER, LA 70714-4911
- **Practice address phone:** (225) 218-4816
- **Practice address fax:** (225) 302-5057
- **Mailing address:** 12902 PLANK RD, BAKER, LA 70714-4911
- **Mailing address phone:** (225) 774-0733
- **Mailing address fax:** (225) 774-7777

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | AP06078 | LA | — |

## Other

- **Enumeration date:** 08/24/2016
- **Last updated:** 07/08/2024