Provider Demographics
NPI:1477509859
Name:PHYSICIANS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEOPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-873-3520
Mailing Address - Street 1:218 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2768
Mailing Address - Country:US
Mailing Address - Phone:985-853-1390
Mailing Address - Fax:985-853-1470
Practice Address - Street 1:218 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2768
Practice Address - Country:US
Practice Address - Phone:985-853-1390
Practice Address - Fax:985-853-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA435282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1947083Medicaid
LA60168OtherBLUE CROSS
LAC1523OtherBLUE CROSS PROFESSIONAL
LA1767611Medicaid
LAC1523OtherBLUE CROSS PROFESSIONAL
LA1767611Medicaid