MEDICARE: OPELOUSAS GENERAL HEALTH SYSTEM PHYSICIAN PRACTICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1003164054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPELOUSAS GENERAL HEALTH SYSTEM PHYSICIAN PRACTICES

Provider Business Mailing Address
First Line	:	PO BOX 1389
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70571-1389
Country	:	US
Telephone Number	:	337-948-5113
Fax Number	:	337-948-5126

Provider Business Practice Location Address
First Line	:	827 N UNION ST
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-6313
Country	:	US
Telephone Number	:	337-948-1802
Fax Number	:	337-942-9074

Authorized Official
Title or Position	:	CFO
Name	:	MR. JAMES B JUNEAU
Credential	:
Telephone Number	:	337-948-5113

Provider Enumeration Date	:	08/23/2012
Last Update Date	:	03/19/2013

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