Organization
JIMMY R COUGHRAN A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY R COUGHRAN M.D. (OWNER)
(318) 435-8020
Entity
Organization
Contact information
Practice address
101 FAIR AVENUE, WINNSBORO, LA 71295-2116
(318) 435-8020
Mailing address
PO BOX 730, WINNSBORO, LA 71295-0730
(318) 435-8020
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
021579
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1449130
—
LA
01
—
433374280A
BCBS OF LA PROVIDER NO
LA
01
—
5287021
AETNA PROVIDER NUMBER
LA
01
—
L92023
VANTAGE PROVIDER NO
LA
Enumeration date
02/19/2007
Last updated
12/13/2012
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