Provider Demographics
NPI:1659413888
Name:MOREHOUSE HOSP. WOMEN'S HEALTH CENTER
Entity Type:Organization
Organization Name:MOREHOUSE HOSP. WOMEN'S HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JANOS
Authorized Official - Middle Name:G
Authorized Official - Last Name:GUOTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-281-8555
Mailing Address - Street 1:316 W WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4522
Mailing Address - Country:US
Mailing Address - Phone:318-281-8555
Mailing Address - Fax:318-281-0820
Practice Address - Street 1:316 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4522
Practice Address - Country:US
Practice Address - Phone:318-281-8555
Practice Address - Fax:318-281-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14422R261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5D096Medicaid