MEDICARE: LGH OB-GYN CLINIC

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	207V00000X	Obstetrics & Gynecology Physician	14790R	LA

General Provider Information

NPI Number	:	1992741854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LGH OB-GYN CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 905
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71273-0905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 E VAUGHN AVE
Second Line	:	SUITE 205
City	:	RUSTON
State	:	LA
Zip	:	71270-5972
Country	:	US
Telephone Number	:	318-513-9661
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. LAMBERTO OPULENCIA FLORES
Credential	:	M.D.
Telephone Number	:	318-513-9661

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	08/22/2020

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