Healthcare Provider Details

I. General information

NPI: 1477009595
Provider Name (Legal Business Name): PHS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64301 HIGHWAY 434
LACOMBE LA
70445-5411
US

IV. Provider business mailing address

64301 HIGHWAY 434
LACOMBE LA
70445-5411
US

V. Phone/Fax

Practice location:
  • Phone: 985-882-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD.207737
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD.019868
License Number StateLA

VIII. Authorized Official

Name: REX HOUSER
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 985-882-4500