1134509649 NPI number — MOREHOUSE COMMUNITY MEDICAL CENTERS, INC

Table of content: (NPI 1134509649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134509649 NPI number — MOREHOUSE COMMUNITY MEDICAL CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOREHOUSE COMMUNITY MEDICAL CENTERS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WEST MONROE HIGH SCHOOL BASED HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134509649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 792
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BASTROP
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71221-0792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-239-8015
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 RIGGS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71291-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-323-3771
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PARNELL
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
318-239-8015

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2396633 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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