Healthcare Provider Details

I. General information

NPI: 1164700118
Provider Name (Legal Business Name): WEST FELICIANA PARISH HOSPITAL PHYSICIAN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5326 OAK ST
SAINT FRANCISVILLE LA
70775-4510
US

IV. Provider business mailing address

PO BOX 487
SAINT FRANCISVILLE LA
70775-0487
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-5848
  • Fax:
Mailing address:
  • Phone: 225-635-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHY M CHEATHAM
Title or Position: DIRECTOR
Credential:
Phone: 225-635-3811