Healthcare Provider Details
I. General information
NPI: 1821149683
Provider Name (Legal Business Name): PHC - MORGAN CITY LP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/16/2007
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1125 MARGUERITE ST
MORGAN CITY LA
70380-1855
US
IV. Provider business mailing address
330 SEVEN SPRINGS WAY
BRENTWOOD TN
37027-4536
US
V. Phone/Fax
- Phone: 985-380-4000
- Fax:
- Phone: 615-920-7000
- Fax: 615-920-8913
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207P00000X |
| Taxonomy | Emergency Medicine Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207V00000X |
| Taxonomy | Obstetrics & Gynecology Physician |
| License Number | |
| License Number State | |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | |
| License Number State | |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208600000X |
| Taxonomy | Surgery Physician |
| License Number | |
| License Number State | |
| # 7 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
ROBERT
N
KLEIN
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7000