Carlock Enterprises LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CARLOCK ENTERPRISES LLC

Practice address

2778 Hwy 121
Suite a
Otis, LA 71466-0000

Phone

(318) 793-5020

Fax

(318) 759-0828

NPI assigned

May 19, 2016

Last updated

Jul 28, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Victor Carlock, FNPNPI 1396948402

Title

FNP/Owner

Phone

(318) 419-5188

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437506474. Details of each certification follow.

• CCN 193955 Rural health clinic · Active · Details

Rural health clinic certification: CCN 193955

Legal name

CARLOCK ENTERPRISES LLC

Doing business as

CARLOCK FAMILY MEDICAL CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Mar 11, 2020

Last certification

Mar 11, 2026

Ownership / control type

1C

Organization structure

LLCProprietary

Enrollment address

2778 Highway 121
Otis, LA 71466-9717

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Carlock Enterprises LLC

  dba Carlock Family Medical Clinic

  • Rural Health Clinic/Center
  • Leesville, LA
  • NPI 1649524257

  3476707514

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Carlock Enterprises LLC

  dba Carlock Family Medical Clinic

  • Rural Health Clinic/Center
  • Leesville, LA
  • NPI 1649524257

  O20130125000277

  Same enrollment

Locations

All disclosed owners & managing parties 2

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

Owners & managing parties with NPI records 2

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

• Jennifer B Carlock, NP

  • Nurse Practitioner
  • Leesville, LA
  • NPI 1164616553

  5% Or Greater Direct Ownership Interest, Limited Partnership Interest, Operational/Managerial Control

  CMS ownership
• Victor Vance Carlock, NP

  • Nurse Practitioner
  • Leesville, LA
  • NPI 1396948402

  5% Or Greater Direct Ownership Interest, Limited Partnership Interest

  CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Carlock Enterprises LLC

  dba Carlock Family Medical Clinic

  • Rural Health Clinic/Center
  • Leesville, LA
  • NPI 1649524257
  NPPES parent name

Practitioners 5

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.

• Victor Vance Carlock, NP

  • Nurse Practitioner
  • Leesville, LA
  • NPI 1396948402
  NPD Authorized official
• Jennifer B Carlock, NP

  • Nurse Practitioner
  • Leesville, LA
  • NPI 1164616553
  NPD
• Robyn Briscoe Dowdle, NP

  • Gerontology Nurse Practitioner
  • Leesville, LA
  • NPI 1871046128
  NPD
• Robert Kenneth Lamme, M.D.

  • Family Medicine Physician
  • Leesville, LA
  • NPI 1548422181
  NPD
• Andrea Wilson, FMP-C

  • Family Nurse Practitioner
  • Natchitoches, LA
  • NPI 1831962901
  NPD

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

{
    "created_epoch": "1463616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1437506474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2778 HWY 121",
            "address_2": "SUITE A",
            "city": "OTIS",
            "state": "LA",
            "postal_code": "714660000",
            "telephone_number": "318-793-5020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2778 HWY 121",
            "address_2": "SUITE A",
            "city": "OTIS",
            "state": "LA",
            "postal_code": "714660000",
            "telephone_number": "318-793-5020",
            "fax_number": "318-759-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLOCK ENTERPRISES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-19",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A",
        "authorized_official_last_name": "CARLOCK",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "FNP/OWNER",
        "authorized_official_telephone_number": "318-419-5188",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Faye Bruyninckx, LMSW

• Primary Care Clinic/Center in Otis, LA
• Providers in Otis, LA by specialty
• Primary Care Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.