PROVIDENCE MEDICAL CLINIC NPI 1700092442

NPI Information

PROVIDENCE MEDICAL CLINIC is a primary care clinic center in Baton Rouge, LA. PROVIDENCE MEDICAL CLINIC NPI is 1700092442. The provider is registered as an organization entity type.

The provider's business location address is:

9270 SIEGEN LN
SUITE 202
BATON ROUGE, LA
ZIP 70810-998
Phone: (225) 766-8152

The provider's authorized official is Cuong Minh Pho .
The authorized official title is Office Manager and has the following contact phone number (225) 766-8152.

The enumeration date for this NPI number is 5/16/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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