| Organization Name: | RICHARDSON MEDICAL CENTER SCHOOL BASED HEALTH CLINIC |
| NPI Number: | 1093996969 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KERRY GOFF (ADMINISTRATOR) |
| Mailing Address: | 155 Hwy 3048 Rayville |
| State: | LA US |
| Postal Code: | 71269 |
| Phone Number: | 3187284181 |
| Fax Number: | |
| NPI Enumeration Date: | 11/20/2007 |
| NPI Last Update Date: | 11/20/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS1000X |
| License Number: | 211 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Student Health |
| Taxonomy Definition: | |