Healthcare Provider Details

I. General information

NPI: 1083648018
Provider Name (Legal Business Name): GULF REGIONAL OCCUPATIONAL MEDICINE CENTER OF ACADIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E ST VICTOR ST
ABBEVILLE LA
70510
US

IV. Provider business mailing address

121 E ST VICTOR ST
ABBEVILLE LA
70510
US

V. Phone/Fax

Practice location:
  • Phone: 337-893-0810
  • Fax: 337-893-0890
Mailing address:
  • Phone: 337-893-0810
  • Fax: 337-893-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.A20081.RX
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.012239
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM.D.012239
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.012239
License Number StateLA

VIII. Authorized Official

Name: MRS. MYRIAM D HUTCHINSON
Title or Position: MANAGER/OWNER
Credential: M.D.
Phone: 337-422-6206