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Organization
AFFINITY HEALTH GROUP, LLC
Active
Organization
AFFINITY HEALTH GROUP, LLC
Active
Other names
Abraham Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE BREARD (VICE PRESIDENT)
(318) 361-0900
Entity
Organization
Contact information
Practice address
261 HWY 132, MANGHAM, LA 71259-0219
(318) 248-2807
(318) 248-2967
Mailing address
130 DESIARD ST, SUITE 355, MONROE, LA 71201-7319
(318) 807-7875
(318) 812-9997
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010064540
RAILROAD MEDICARE
LA
05
—
1444162
—
LA
01
—
439966080C
BLUE CROSS BLUE SHIELD
LA
Enumeration date
05/22/2006
Last updated
12/07/2011
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