# AFFINITY HEALTH GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Abraham Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902850035
- **Authorized official:** MR. MIKE BREARD (VICE PRESIDENT)
- **Authorized official phone:** (318) 361-0900

## Contact information

- **Practice address:** 261 HWY 132, MANGHAM, LA 71259-0219
- **Practice address phone:** (318) 248-2807
- **Practice address fax:** (318) 248-2967
- **Mailing address:** 130 DESIARD ST, SUITE 355, MONROE, LA 71201-7319
- **Mailing address phone:** (318) 807-7875
- **Mailing address fax:** (318) 812-9997

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2006
- **Last updated:** 12/07/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 010064540 | RAILROAD MEDICARE | LA |
| 05 | — | 1444162 | — | LA |
| 01 | — | 439966080C | BLUE CROSS BLUE SHIELD | LA |