Provider Demographics
NPI:1013551100
Name:OUTPATIENT MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:OUTPATIENT MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ISIAH
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:318-357-2055
Mailing Address - Street 1:1640 BREAZEALE SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-4278
Mailing Address - Country:US
Mailing Address - Phone:318-357-2071
Mailing Address - Fax:
Practice Address - Street 1:520 SAINT MAURICE LN
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6199
Practice Address - Country:US
Practice Address - Phone:318-357-2071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTPATIENT MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)