Provider Demographics
NPI:1881679207
Name:PORT ASSOCIATES MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PORT ASSOCIATES MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:FILIPINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-351-2076
Mailing Address - Street 1:PO BOX 1320
Mailing Address - Street 2:17449 HWY 190 WEST
Mailing Address - City:PORT BARRE
Mailing Address - State:LA
Mailing Address - Zip Code:70577-1320
Mailing Address - Country:US
Mailing Address - Phone:337-585-5270
Mailing Address - Fax:337-585-5270
Practice Address - Street 1:17449 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:PORT BARRE
Practice Address - State:LA
Practice Address - Zip Code:70577-5126
Practice Address - Country:US
Practice Address - Phone:337-585-5270
Practice Address - Fax:337-585-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
5CP19Medicare ID - Type Unspecified