Organization
AFFINITY HEALTH GROUP, LLC
Active
Other names
Abraham Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE BREARD (VICE PRESIDENT)
(318) 361-0900
Entity
Organization
Contact information
Practice address
261 HWY 132, MANGHAM, LA 71259-0219
(318) 248-2807
(318) 248-2967
Mailing address
130 DESIARD ST, SUITE 355, MONROE, LA 71201-7319
(318) 807-7875
(318) 812-9997
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010064540
RAILROAD MEDICARE
LA
05
—
1444162
—
LA
01
—
439966080C
BLUE CROSS BLUE SHIELD
LA
Enumeration date
05/22/2006
Last updated
12/07/2011
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