Provider Demographics
NPI:1003420217
Name:PHOENIX MEDICAL HEALTHCARE CENTER, INC
Entity Type:Organization
Organization Name:PHOENIX MEDICAL HEALTHCARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NSIKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-354-6081
Mailing Address - Street 1:PO BOX 27763
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2029
Mailing Address - Country:US
Mailing Address - Phone:617-402-1000
Mailing Address - Fax:
Practice Address - Street 1:215 EVERETT ST
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-3618
Practice Address - Country:US
Practice Address - Phone:985-354-6081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty