Provider Demographics
NPI:1356898589
Name:MOREHOUSE COMMUNITY MEDICAL CENTERS, INC
Entity type:Organization
Organization Name:MOREHOUSE COMMUNITY MEDICAL CENTERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-556-8454
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0792
Mailing Address - Country:US
Mailing Address - Phone:318-239-8015
Mailing Address - Fax:318-281-2559
Practice Address - Street 1:501 DURHAM ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5012
Practice Address - Country:US
Practice Address - Phone:318-283-8887
Practice Address - Fax:318-281-2559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOREHOUSE COMMUNITY MEDICAL CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-06
Last Update Date:2024-06-18
Deactivation Date:2023-09-11
Deactivation Code:
Reactivation Date:2024-06-12
Provider Licenses
StateLicense IDTaxonomies
363LF0000X, 363LP0808X
LA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2429167Medicaid