Healthcare Provider Details

I. General information

NPI: 1174217061
Provider Name (Legal Business Name): MOREHOUSE COMMUNITY MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 N FRANKLIN ST STE C
BASTROP LA
71220-3846
US

IV. Provider business mailing address

PO BOX 792
BASTROP LA
71221-0792
US

V. Phone/Fax

Practice location:
  • Phone: 318-283-8887
  • Fax:
Mailing address:
  • Phone: 318-283-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH SPIKES
Title or Position: ADMINISTRATIVE SERVICES COORDINATOR
Credential:
Phone: 318-556-8454