Provider Demographics
NPI:1902835150
Name:DEER CREEK MEDICAL CENTER
Entity Type:Organization
Organization Name:DEER CREEK MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMPM
Authorized Official - Phone:337-238-0167
Mailing Address - Street 1:301 W FERTITTA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4665
Mailing Address - Country:US
Mailing Address - Phone:337-238-0167
Mailing Address - Fax:337-238-0574
Practice Address - Street 1:301 W FERTITTA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4665
Practice Address - Country:US
Practice Address - Phone:337-238-0167
Practice Address - Fax:337-238-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1949477Medicaid
LA1949477Medicaid
LA=========0OtherBLUE CROSS BLUE SHIELD