Provider Demographics
NPI:1134348162
Name:COMPREHENSIVE CARE PLUS
Entity type:Organization
Organization Name:COMPREHENSIVE CARE PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOIRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-868-3737
Mailing Address - Street 1:PO BOX 3873
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-3873
Mailing Address - Country:US
Mailing Address - Phone:985-868-3737
Mailing Address - Fax:985-873-9997
Practice Address - Street 1:8120 MAIN ST
Practice Address - Street 2:SUITE 403
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3403
Practice Address - Country:US
Practice Address - Phone:985-868-3737
Practice Address - Fax:985-873-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023805208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1485284Medicaid
LAH24976Medicare UPIN
LA1485284Medicaid