Healthcare Provider Details

I. General information

NPI: 1992828123
Provider Name (Legal Business Name): OUACHITA NEUROSURGERY CENTER A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 WALNUT ST SUITE 110
MONROE LA
71201-6700
US

IV. Provider business mailing address

212 WALNUT ST SUITE 110
MONROE LA
71201-6700
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1809
  • Fax: 318-323-2668
Mailing address:
  • Phone: 318-323-1809
  • Fax: 318-323-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number021731
License Number StateLA

VIII. Authorized Official

Name: DR. BERNIE G. MCHUGH JR.
Title or Position: PHYSICIAN
Credential: M. D.
Phone: 318-323-1809