Healthcare Provider Details

I. General information

NPI: 1356898589
Provider Name (Legal Business Name): MOREHOUSE COMMUNITY MEDICAL CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date: 09/11/2023
Reactivation Date: 06/12/2024

III. Provider practice location address

501 DURHAM ST
BASTROP LA
71220-5012
US

IV. Provider business mailing address

PO BOX 792
BASTROP LA
71221-0792
US

V. Phone/Fax

Practice location:
  • Phone: 318-283-8887
  • Fax: 318-281-2559
Mailing address:
  • Phone: 318-239-8015
  • Fax: 318-281-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateLA

VIII. Authorized Official

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