Provider Demographics
NPI:1609683937
Name:CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED
Entity type:Organization
Organization Name:CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-650-2026
Mailing Address - Street 1:PO BOX 66156
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6156
Mailing Address - Country:US
Mailing Address - Phone:225-650-2000
Mailing Address - Fax:
Practice Address - Street 1:20474 OLD SCENIC HWY
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7365
Practice Address - Country:US
Practice Address - Phone:225-478-1174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)