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General NPI Number Information
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NPI Number | 1669559373
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Entity Type | Organization
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Legal Business Name | MOREHOUSE OUACHITA SURGERY ASSOCIATES
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 05/10/2019
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Provider Practice Location Address
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Address Line | 631 RB WILSON DR STE 2
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City | HUNTINGDON
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State | TN
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Zip | 38344-1727
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Country | US
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Telephone | 731-358-4287
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Fax | 731-393-0098
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Provider Business Mailing Address
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Address Line | 631 RB WILSON DR STE 2
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City | HUNTINGDON
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State | TN
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Zip | 38344-1727
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Country | US
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Telephone | 731-358-4287
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Fax | 731-393-0098
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LISA KAY PAGE
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Credential |
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Telephone | 731-693-3465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 016434
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License Number State | ME
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