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Organization
COUNTRY CLINIC, LLC
Active
Organization
COUNTRY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSE KUPLESKY RN (OWNER/MANAGER)
(318) 941-2057
Entity
Organization
Contact information
Practice address
314 CHRISTINE LN, SIMMESPORT, LA 71369-2256
(318) 941-2057
(318) 941-2067
Mailing address
PO BOX 80735, LAFAYETTE, LA 70598-0735
(800) 564-8971
(866) 693-1704
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
025398
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1445665
—
LA
Enumeration date
05/08/2006
Last updated
11/13/2014
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