Organization
NEW LIFE MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MIRIAM SONG STACEY (OWNER)
(985) 542-7392
Entity
Organization
Contact information
Practice address
50057 HWY 51 NORTH, TICKFAW, LA 70466
(985) 542-7392
(985) 542-7393
Mailing address
50057 HWY 51 NORTH, TICKFAW, LA 70466
(985) 542-7392
(985) 542-7393
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
LA
Other
Enumeration date
10/05/2009
Last updated
10/05/2009
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