Provider Demographics
NPI:1659571669
Name:HOUMA OB-GYN CLINIC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HOUMA OB-GYN CLINIC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PITRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-876-1714
Mailing Address - Street 1:1007 BELANGER ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4705
Mailing Address - Country:US
Mailing Address - Phone:985-876-1714
Mailing Address - Fax:985-868-6549
Practice Address - Street 1:1007 BELANGER STREET
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4705
Practice Address - Country:US
Practice Address - Phone:985-876-1714
Practice Address - Fax:985-868-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07852R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA57788Medicare PIN