Healthcare Provider Details

I. General information

NPI: 1548322365
Provider Name (Legal Business Name): MORGAN CITY ORTHOPEDIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 DAVID DRIVE SUITE 103
MORGAN CITY LA
70380
US

IV. Provider business mailing address

PO BOX 2375
MORGAN CITY LA
70381
US

V. Phone/Fax

Practice location:
  • Phone: 985-384-7900
  • Fax: 985-384-8049
Mailing address:
  • Phone: 985-384-7900
  • Fax: 985-384-8049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberL04053R
License Number StateLA

VIII. Authorized Official

Name: DR. JEFFREY C FITTER
Title or Position: OWNER/PHYSICIAN
Credential: MD.
Phone: 985-384-7900