Organization
AFFINITY HEALTH GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE BREARD (VICE PRESIDENT)
(318) 361-0900
Entity
Organization
Contact information
Practice address
112 SAINT JOHN ST, MONROE, LA 71201-7322
(318) 387-5681
(318) 322-9957
Mailing address
130 DESIARD STREET, STE. 355, MONROE, LA 71201-7363
(318) 807-7875
(318) 812-6603
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
133V00000X
Registered Dietitian
—
—
183500000X
Pharmacist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
225100000X
Physical Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1153061
—
LA
Enumeration date
12/11/2007
Last updated
09/08/2023
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