Provider Demographics
NPI:1083648018
Name:GULF REGIONAL OCCUPATIONAL MEDICINE CENTER OF ACADIANA
Entity Type:Organization
Organization Name:GULF REGIONAL OCCUPATIONAL MEDICINE CENTER OF ACADIANA
Other - Org Name:GULF REGIONAL OCCMED & WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-422-6206
Mailing Address - Street 1:121 E ST VICTOR ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510
Mailing Address - Country:US
Mailing Address - Phone:337-893-0810
Mailing Address - Fax:337-893-0890
Practice Address - Street 1:121 E ST VICTOR ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510
Practice Address - Country:US
Practice Address - Phone:337-893-0810
Practice Address - Fax:337-893-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.012239207P00000X, 207R00000X
LAM.D.012239207Q00000X
LAPA.A20081.RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5CV01Medicare PIN