Provider Demographics
NPI:1316406929
Name:OPELOUSAS GENERAL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:OPELOUSAS GENERAL HOSPITAL AUTHORITY
Other - Org Name:WELLSMART HEALTH OF OPELOUSAS RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-594-3499
Mailing Address - Street 1:539 E PRUDHOMME ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6499
Mailing Address - Country:US
Mailing Address - Phone:337-594-3499
Mailing Address - Fax:
Practice Address - Street 1:1200 HOSPITAL DR STE 5
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6552
Practice Address - Country:US
Practice Address - Phone:337-594-3499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPELOUSAS GENERAL HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-14
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health