Provider Demographics
NPI:1114252558
Name:MOREHOUSE COMMUNITY MEDICAL CENTERS, INC
Entity Type:Organization
Organization Name:MOREHOUSE COMMUNITY MEDICAL CENTERS, INC
Other - Org Name:MOREHOUSE ELEMENTARY SCHOOL BASED HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
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 1:1001 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4331
Practice Address - Country:US
Practice Address - Phone:318-281-8422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOREHOUSE COMMUNITY MEDICAL CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-02
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X, 363LP0200X
LA05544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1803898Medicaid