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General NPI Number Information
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NPI Number | 1659571669
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Entity Type | Organization
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Legal Business Name | HOUMA OB-GYN CLINIC A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 1007 BELANGER STREET
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City | HOUMA
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State | LA
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Zip | 70360-4705
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Country | US
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Telephone | 985-876-1714
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Fax | 985-868-6549
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Provider Business Mailing Address
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Address Line | 1007 BELANGER ST
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City | HOUMA
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State | LA
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Zip | 70360-4705
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Country | US
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Telephone | 985-876-1714
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Fax | 985-868-6549
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TAMMY LYNN PITRE
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Credential |
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Telephone | 985-876-1714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 07852R
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License Number State | LA
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