Organization
PROVIDENCE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CUONG MINH PHO (OFFICE MANAGER)
(225) 766-8152
Entity
Organization
Contact information
Practice address
9270 SIEGEN LN, SUITE 202, BATON ROUGE, LA 70810-1998
(225) 766-8152
Mailing address
1229 TANGLEBRIAR DR, BATON ROUGE, LA 70810-5195
(225) 766-4213
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
LA
Other
Enumeration date
05/16/2007
Last updated
08/22/2020
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