MEDICARE: PHC-OPELOUSAS LP

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	273R00000X	Psychiatric Hospital Unit	417-A	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427122969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHC-OPELOUSAS LP

Provider Business Mailing Address
First Line	:	103 POWELL CT
Second Line	:	STE. 200
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5079
Country	:	US
Telephone Number	:	615-372-8500
Fax Number	:	615-372-8572

Provider Business Practice Location Address
First Line	:	225 GUIDROZ
Second Line	:
City	:	ARNAUDVILLE
State	:	LA
Zip	:	70512
Country	:	US
Telephone Number	:	318-754-5557
Fax Number	:	318-754-5552

Authorized Official
Title or Position	:	COO
Name	:	WILLIAM M. GRACEY
Credential	:
Telephone Number	:	615-372-8500

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	09/09/2008

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Directions to “PHC-OPELOUSAS LP ” Practice Location

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