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General NPI Number Information
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NPI Number | 1902835150
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Entity Type | Organization
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Legal Business Name | DEER CREEK MEDICAL CENTER
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 301 W FERTITTA BLVD STE 1
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City | LEESVILLE
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State | LA
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Zip | 71446-4665
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Country | US
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Telephone | 337-238-0167
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Fax | 337-238-0574
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Provider Business Mailing Address
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Address Line | 301 W FERTITTA BLVD STE 1
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City | LEESVILLE
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State | LA
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Zip | 71446-4665
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Country | US
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Telephone | 337-238-0167
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Fax | 337-238-0574
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | LISA THOMPSON
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Credential | CMPM
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Telephone | 337-238-0167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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