Provider Demographics
NPI:1275622615
Name:PHC-OPELOUSAS LP
Entity Type:Organization
Organization Name:PHC-OPELOUSAS LP
Other - Org Name:DOCTORS HOSPITAL OF OPELOUSAS-REHABILITATION UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:103 POWELL CT
Mailing Address - Street 2:STE. 200
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5079
Mailing Address - Country:US
Mailing Address - Phone:615-372-8500
Mailing Address - Fax:615-372-8572
Practice Address - Street 1:3983 I 49 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0758
Practice Address - Country:US
Practice Address - Phone:337-948-2100
Practice Address - Fax:337-948-2173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHC-OPELOUSAS LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-12
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60086OtherBLUE CROSS
19T191Medicare Oscar/Certification