MEDICARE: OUTPATIENT MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	207Q00000X	Family Medicine Physician
3	208000000X	Pediatrics Physician
4	363L00000X	Nurse Practitioner
5	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871523266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTPATIENT MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	1640 BREAZEALE SPRINGS ST
Second Line	:
City	:	NATCHITOCHES
State	:	LA
Zip	:	71457-4278
Country	:	US
Telephone Number	:	318-352-9299
Fax Number	:	318-352-0203

Provider Business Practice Location Address
First Line	:	1640 BREAZEALE SPRINGS ST
Second Line	:
City	:	NATCHITOCHES
State	:	LA
Zip	:	71457
Country	:	US
Telephone Number	:	318-352-9299
Fax Number	:	318-352-0203

Authorized Official
Title or Position	:	CEO
Name	:	CARL ISIAH WALTERS
Credential	:
Telephone Number	:	318-357-2055

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/29/2018

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Directions to “OUTPATIENT MEDICAL CENTER, INC. ” Practice Location

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