Provider Demographics
NPI:1477888774
Name:OUTPATIENT PHYSICIAN PRACTICE NO 5
Entity Type:Organization
Organization Name:OUTPATIENT PHYSICIAN PRACTICE NO 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-966-7369
Mailing Address - Street 1:PO BOX 3249
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-3249
Mailing Address - Country:US
Mailing Address - Phone:318-396-2715
Mailing Address - Fax:
Practice Address - Street 1:500 HALL ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7531
Practice Address - Country:US
Practice Address - Phone:318-966-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-05
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty