MEDICARE: CAMERON OPCO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		TX

General Provider Information

NPI Number	:	1457856775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMERON OPCO LLC

Provider Business Mailing Address
First Line	:	2431 S ACADIAN THRUWAY STE 100
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-2300
Country	:	US
Telephone Number	:	225-800-4954
Fax Number	:	225-308-2278

Provider Business Practice Location Address
First Line	:	2202 N TRAVIS AVE
Second Line	:
City	:	CAMERON
State	:	TX
Zip	:	76520
Country	:	US
Telephone Number	:	254-697-6564
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	VICTOR DEVIN GUM
Credential	:
Telephone Number	:	225-800-4954

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	11/30/2023

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