Provider Demographics
NPI:1942656228
Name:PHYSICIANS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL CENTER LLC
Other - Org Name:PHYSICIANS PRIMARY CARE HOUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5900
Mailing Address - Street 1:218 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2768
Mailing Address - Country:US
Mailing Address - Phone:985-580-9990
Mailing Address - Fax:985-580-9984
Practice Address - Street 1:131 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2767
Practice Address - Country:US
Practice Address - Phone:985-580-9990
Practice Address - Fax:985-580-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
5F804OtherPART B