NPIMap

Organization Active NPI

T & T Klick, LLC

Doing business as Family Care Clinic

  • Primary Care Clinic/Center
  • Mangham, LA
National Provider Identifier
1023399888
Registry record updated Oct 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
APO6543 Issued in LA
Legal business name
T & T KLICK, LLC
Doing business as
Family Care Clinic
Practice address
107 Lela St
Mangham, LA 71259-5063
Phone
(318) 248-4100
Fax
(318) 248-4103
NPI assigned
Sep 6, 2011
Last updated
Oct 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Terri Lynn Klick, FNP-CNPI 1558649905
Title
Owner
Phone
(318) 248-4100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X APO6543 LA Primary

Addresses

Primary practice location

107 Lela St
Mangham, LA 71259-5063

Mailing address

107 Lela St
Mangham, LA 71259-5063
Phone (318) 248-4100

Other names 1

  • Family Care Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111028000357 LA Part B Supplier - Clinic/Group Practice 8729251244 Receives reassigned benefits from 4 practitioners
Practice locations: Mangham, LA
O20121212000121 LA Part A Provider - Rural Health Clinic 8729251244 Practice locations: Mangham, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023399888. Details of each certification follow.

Rural health clinic certification: CCN 193905

Legal name
T & T KLICK, LLC
Doing business as
FAMILY CARE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 25, 2013
Last certification
Mar 25, 2025
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
in LA
Enrollment address
107 Lela Street
Mangham, LA 71259-5063

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2033306Family Care Clinic107 Lela St, Mangham, LA 71259Certificate of waiverNov 28, 2027

National Provider Directory

National Provider Directory

Locations

107 Lela St
Mangham, LA 71259
Phone (318) 248-4100

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Terri L Klick Individual 5% Or Greater Direct Ownership Interest Oct 3, 2011 60%
5% Or Greater Indirect Ownership Interest Oct 3, 2011 60%
W-2 Managing Employee Oct 3, 2011 60%
Operational/Managerial Control Oct 3, 2011 60%
Other Oct 3, 2011 60%
Donna Roberts Individual 5% Or Greater Direct Ownership Interest Oct 3, 2011 40%
5% Or Greater Indirect Ownership Interest Oct 3, 2011 40%
W-2 Managing Employee Oct 3, 2011
Operational/Managerial Control Oct 3, 2011 40%
Other Oct 3, 2011 70%
Todd Roberts Individual Other Oct 3, 2011
Timothy Klick Individual Other Oct 3, 2011

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Terri Lynn Klick, FNP-C
    • Family Nurse Practitioner
    • Mangham, LA
    • NPI 1558649905

    5% Or Greater Direct Ownership Interest, 5% Or Greater Indirect Ownership Interest, Operational/Managerial Control, Other, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319068800000",
    "number": "1023399888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 LELA ST",
            "city": "MANGHAM",
            "state": "LA",
            "postal_code": "712595063",
            "telephone_number": "318-248-4100",
            "fax_number": "318-248-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 LELA ST",
            "city": "MANGHAM",
            "state": "LA",
            "postal_code": "712595063",
            "telephone_number": "318-248-4100",
            "fax_number": "318-248-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "T & T KLICK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-06",
        "last_updated": "2011-10-20",
        "status": "A",
        "authorized_official_last_name": "KLICK",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-248-4100",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "LA",
            "license": "APO6543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mangham, LA

Sources for this page

Verify at the official NPI Registry.