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Organization

SOUTH LOUISIANA PRIMARY CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DUSTIN ALLEN LOGUE ANP (OWNER)
(225) 774-0733
Entity
Organization

Contact information

Practice address
12902 PLANK RD, BAKER, LA 70714-4911
(225) 218-4816
(225) 302-5057
Mailing address
12902 PLANK RD, BAKER, LA 70714-4911
(225) 774-0733
(225) 774-7777

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
261QP2300X
Primary Care Clinic/Center
AP06078
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2110691
LA
Enumeration date
08/24/2016
Last updated
07/08/2024
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