Provider Demographics
NPI:1023340254
Name:WOMEN'S CLINIC OF OAKDALE, LLC
Entity type:Organization
Organization Name:WOMEN'S CLINIC OF OAKDALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEDHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KULKARNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-468-2250
Mailing Address - Street 1:805 CHERRY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2223
Mailing Address - Country:US
Mailing Address - Phone:337-468-2250
Mailing Address - Fax:337-468-2702
Practice Address - Street 1:119 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-3034
Practice Address - Country:US
Practice Address - Phone:318-335-0260
Practice Address - Fax:318-335-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05120R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2121014OtherAMERIGROUP CCN
LA53433DM43OtherGROUP MEMBER PTAN
19-3898OtherMEDICAE PART A
LA2121014OtherUNITED HEALTHCARE CCN
LA2121014Medicaid
LA5DM43OtherMEDICARE PTAN
LA2121014OtherCOMMUNITY HEALTH SOLUTIONS CCN