Organization
BLUEBONNET FAMILY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYKUTTY J THOMAS M.D. (OWNER)
(225) 757-6031
Entity
Organization
Contact information
Practice address
9241 BLUEBONNET BLVD, SUITE B, BATON ROUGE, LA 70810-2808
(225) 757-6031
(225) 757-6035
Mailing address
9241 BLUEBONNET BLVD, SUITE B, BATON ROUGE, LA 70810-2808
(225) 757-6031
(225) 757-6035
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
022386
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1676471
—
LA
Enumeration date
10/04/2007
Last updated
10/04/2007
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