NPIMap

Organization Active NPI

Dry Prong Family Clinic, LLC

Doing business as Dry Prong Family Clinic

  • Rural Health Clinic/Center
  • Dry Prong, LA
National Provider Identifier
1366928277
Registry record updated Jun 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DRY PRONG FAMILY CLINIC, LLC
Doing business as
Dry Prong Family Clinic
Practice address
800 Grove Street
Dry Prong, LA 71423
Phone
(318) 568-8298
Fax
(318) 568-8297
NPI assigned
Jul 13, 2018
Last updated
Jun 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2020

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

Authorized official

Name
Benjamin Colvin, FNPNPI 1730425281
Title
Owner
Phone
(318) 568-8298

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

800 Grove Street
Dry Prong, LA 71423

Mailing address

PO Box 37
Montgomery, LA 71454-0037

Other names 1

  • Dry Prong Family Clinic Doing business as

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
19D2164593Dry Prong Family Clinic800 Grove Street, Dry Prong, LA 71423Certificate of waiverApr 8, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14634/brand/2/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

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": "1531440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591056000000",
    "number": "1366928277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37",
            "city": "MONTGOMERY",
            "state": "LA",
            "postal_code": "714540037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 GROVE STREET",
            "city": "DRY PRONG",
            "state": "LA",
            "postal_code": "71423",
            "telephone_number": "318-568-8298",
            "fax_number": "318-568-8297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRY PRONG FAMILY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-13",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A",
        "authorized_official_last_name": "COLVIN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-568-8298",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dry Prong Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dry Prong Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dry Prong, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.