Healthcare Provider Details

I. General information

NPI: 1366684201
Provider Name (Legal Business Name): OCEANS PHYSICIANS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 HEATHER DR
OPELOUSAS LA
70570-7714
US

IV. Provider business mailing address

127 W BROAD ST SUITE 700
LAKE CHARLES LA
70601-4291
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-8820
  • Fax: 347-948-8821
Mailing address:
  • Phone: 337-721-1900
  • Fax: 337-721-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY J REED
Title or Position: C.E.O.
Credential:
Phone: 337-721-1900