Provider Demographics
NPI:1811001548
Name:AMBULATORY SURGERY CENTER OF OPELOUSAS
Entity Type:Organization
Organization Name:AMBULATORY SURGERY CENTER OF OPELOUSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-832-2115
Mailing Address - Street 1:1207 N CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-4129
Mailing Address - Country:US
Mailing Address - Phone:504-832-2115
Mailing Address - Fax:504-832-2116
Practice Address - Street 1:187 VENTRE BLVD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-9145
Practice Address - Country:US
Practice Address - Phone:337-407-0050
Practice Address - Fax:337-407-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA114261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1148199Medicaid
LA11083OtherPTAN
LA190020205ZOtherBLUE CROSS OF LA
LA190020205ZOtherBLUE CROSS OF LA