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Organization
BYRD MEDICAL CLINIC INC
Active
Organization
BYRD MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY CROCKETT WILEY (MSO DIRECTOR)
(337) 392-6200
Entity
Organization
Contact information
Practice address
700 S 6TH ST, LEESVILLE, LA 71446-4719
(337) 392-6200
Mailing address
700 S 6TH ST, LEESVILLE, LA 71446-4719
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
LA
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
NULL
207Y00000X
Otolaryngology Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
NULL
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1944718
—
LA
Enumeration date
07/18/2005
Last updated
08/19/2021
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