Provider Demographics
NPI:1891821880
Name:OPELOUSAS GENERAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:OPELOUSAS GENERAL HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:I
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-948-3011
Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-1389
Mailing Address - Country:US
Mailing Address - Phone:337-948-3011
Mailing Address - Fax:337-948-5126
Practice Address - Street 1:539 E PRUDHOMME ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6499
Practice Address - Country:US
Practice Address - Phone:337-948-3011
Practice Address - Fax:337-948-5126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA125332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3912350001Medicare ID - Type Unspecified