Provider Demographics
NPI:1538244884
Name:HUMPHRIES FAMILY HEALTHCARE, LLC
Entity type:Organization
Organization Name:HUMPHRIES FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:TORRELL
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-263-4958
Mailing Address - Street 1:PO BOX 4492
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-4492
Mailing Address - Country:US
Mailing Address - Phone:337-479-0212
Mailing Address - Fax:337-474-7475
Practice Address - Street 1:3101 LAKE ST
Practice Address - Street 2:SUITE 128
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8337
Practice Address - Country:US
Practice Address - Phone:337-479-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024656261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care