Healthcare Provider Details

I. General information

NPI: 1114003050
Provider Name (Legal Business Name): NATCHITOCHES OUTPATIENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 KEYSER AVE SUITE E
NATCHITOCHES LA
71457-6037
US

IV. Provider business mailing address

PO BOX 2154
NATCHITOCHES LA
71457-2154
US

V. Phone/Fax

Practice location:
  • Phone: 318-214-0088
  • Fax: 318-214-4493
Mailing address:
  • Phone: 318-214-4200
  • Fax: 318-214-4493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. GERARD R HEBERT
Title or Position: CFO
Credential:
Phone: 318-214-4200