Organization
LOUISIANA FAMILY MEDICINE CLINIC 1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIRK TIMOTHY RAINWATER M.D. (CEO)
(318) 560-3486
Entity
Organization
Contact information
Practice address
103 WATTS ST, JONESBORO, LA 71251-2053
(318) 259-1569
(318) 259-8523
Mailing address
103 WATTS ST, JONESBORO, LA 71251-2053
(318) 259-1569
(318) 259-8523
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
025000
LA
261QU0200X
Urgent Care Clinic/Center
025000
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2344188
—
LA
Enumeration date
12/09/2011
Last updated
06/18/2015
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