Provider Demographics
NPI:1700964764
Name:OPELOUSAS ORTHOPAEDIC CLINIC
Entity Type:Organization
Organization Name:OPELOUSAS ORTHOPAEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:BENNY
Authorized Official - Last Name:FUSILIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-942-6503
Mailing Address - Street 1:4015 HWY I 49 SOUTH SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570
Mailing Address - Country:US
Mailing Address - Phone:337-942-6503
Mailing Address - Fax:337-942-8831
Practice Address - Street 1:4015 HWY I 49 SOUTH SERVICE RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-942-6503
Practice Address - Fax:337-942-8831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA114693Medicaid
LA0177150001Medicare NSC
LA114693Medicaid