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Organization

DESOTO REGIONAL FAMILY MEDICINE

Active
Other names
DeSoto Regional Family Medicine - Mansfield
Organization subpart
No

Provider details

NPI number
Authorized official
HALLIE DEUTSCH (CREDENTIALING SPECIALIST)
(318) 871-3101
Entity
Organization

Contact information

Practice address
130 JEFFERSON ST, MANSFIELD, LA 71052-2602
(318) 872-2700
(318) 872-6214
Mailing address
130 JEFFERSON ST, MANSFIELD, LA 71052-2602
(318) 872-2700
(318) 872-6214

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
LA
261QR1300X
Rural Health Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1948357
LA
01
CN5547
RR MEDICARE
LA
Enumeration date
02/06/2007
Last updated
03/27/2023
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