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Organization

COUNTRY CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ROSE KUPLESKY RN (OWNER/MANAGER)
(318) 941-2057
Entity
Organization

Contact information

Practice address
314 CHRISTINE LN, SIMMESPORT, LA 71369-2256
(318) 941-2057
(318) 941-2067
Mailing address
PO BOX 80735, LAFAYETTE, LA 70598-0735
(800) 564-8971
(866) 693-1704

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
025398
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1445665
LA
Enumeration date
05/08/2006
Last updated
11/13/2014
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