Healthcare Provider Details

I. General information

NPI: 1134348162
Provider Name (Legal Business Name): COMPREHENSIVE CARE PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 MAIN ST SUITE 403
HOUMA LA
70360-3403
US

IV. Provider business mailing address

PO BOX 3873
HOUMA LA
70361-3873
US

V. Phone/Fax

Practice location:
  • Phone: 985-868-3737
  • Fax: 985-873-9997
Mailing address:
  • Phone: 985-868-3737
  • Fax: 985-873-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number023805
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number023805
License Number StateLA

VIII. Authorized Official

Name: MOIRA LYNN OGDEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 985-868-3737