Provider Demographics
NPI:1164700118
Name:WEST FELICIANA PARISH HOSPITAL PHYSICIAN CLINIC
Entity Type:Organization
Organization Name:WEST FELICIANA PARISH HOSPITAL PHYSICIAN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHEATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-635-3811
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-0487
Mailing Address - Country:US
Mailing Address - Phone:225-635-5848
Mailing Address - Fax:
Practice Address - Street 1:5326 OAK ST
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-4510
Practice Address - Country:US
Practice Address - Phone:225-635-5848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST FELICIANA PARISH HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty