Healthcare Provider Details

I. General information

NPI: 1154832434
Provider Name (Legal Business Name): OUTPATIENT MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 GOLD ST
NATCHITOCHES LA
71457-4221
US

IV. Provider business mailing address

1640 BREAZEALE SPRINGS ST
NATCHITOCHES LA
71457-4278
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-9299
  • Fax: 318-356-9546
Mailing address:
  • Phone: 318-352-9299
  • Fax: 318-356-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ANGELLE ANSARDI
Title or Position: HR COORDINATOR
Credential:
Phone: 318-357-2071