Provider Demographics
NPI:1336308022
Name:PHC-OPELOUSAS LP
Entity Type:Organization
Organization Name:PHC-OPELOUSAS LP
Other - Org Name:DOCTORS HOSPITAL OF OPELOUSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:3983 I 49 S SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0758
Mailing Address - Country:US
Mailing Address - Phone:337-948-2107
Mailing Address - Fax:337-948-2173
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:337-948-2107
Practice Address - Fax:337-948-2173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHC-OPELOUSAS LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-06
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207L00000X, 207P00000X, 207Q00000X, 207R00000X, 2085R0202X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACH1013OtherRAILROAD MEDICARE
LA1706841Medicaid
LACH1013OtherRAILROAD MEDICARE