Organization Active NPI

Bogalusa Family Practice

  • General Practice Physician
  • Bogalusa, LA
National Provider Identifier
1104084839
Registry record updated May 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
MD107924 Issued in LA
Legal business name
BOGALUSA FAMILY PRACTICE
Practice address
433 Plaza St
Bogalusa, LA 70427-3729
Phone
(985) 735-1198
NPI assigned
May 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2008

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

Authorized official

Name
Melvin Lester
Title
Billing Clerk
Phone
(985) 732-1899

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X MD107924 LA Primary

Addresses

Primary practice location

433 Plaza St
Bogalusa, LA 70427-3729

Mailing address

PO Box 700
Bogalusa, LA 70429-0700

Other identifiers 1

IdentifierTypeStateIssuer
1365858MedicaidLA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212019200000",
    "number": "1104084839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 700",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704290700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 PLAZA ST",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704273729",
            "telephone_number": "985-735-1198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOGALUSA FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-29",
        "last_updated": "2008-05-29",
        "status": "A",
        "authorized_official_last_name": "LESTER",
        "authorized_official_first_name": "MELVIN",
        "authorized_official_title_or_position": "BILLING CLERK",
        "authorized_official_telephone_number": "985-732-1899"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "LA",
            "license": "MD107924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1365858",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bogalusa, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.