Provider Demographics
NPI:1083802060
Name:MOREHOUSE COMMUNITY MEDICAL CENTERS, INC
Entity Type:Organization
Organization Name:MOREHOUSE COMMUNITY MEDICAL CENTERS, INC
Other - Org Name:COMMUNIHEALTH SERVICES - FAMILY PRACTICE AND BEHAVIORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-239-8015
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0792
Mailing Address - Country:US
Mailing Address - Phone:318-239-8015
Mailing Address - Fax:
Practice Address - Street 1:518-520 DURHAM STREET
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5033
Practice Address - Country:US
Practice Address - Phone:318-283-8887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOREHOUSE COMMUNITY MEDICAL CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-04
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD14979R207Q00000X
LAMD14862R208000000X
261QF0400X
LAAP 04477363LF0000X
LAAP 03448363LF0000X
LAAPRN 05320363LF0000X
LAAP 05342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1019798Medicaid
LA19-1857Medicare PIN