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Organization

YOUR FAMILY CARE CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. EDISON L ONG MD (OWNER)
(337) 276-5408
Entity
Organization

Contact information

Practice address
2412 PALMLAND BLVD, NEW IBERIA, LA 70563-2913
(337) 519-4740
Mailing address
303 BAYSIDE RD, JEANERETTE, LA 70544-5801
(337) 276-5408
(337) 276-5452

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
12332R
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12332R
MEDICAL LICENSE
LA
05
1530301
LA
01
1598794406
PROVIDER NPI
LA
Enumeration date
06/16/2009
Last updated
06/16/2009
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