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Organization
OLD RIVER PHYSICIAN SERVICES, LLC
Active
Organization
OLD RIVER PHYSICIAN SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C FALK (VICE PRESIDENT)
(337) 609-1221
Entity
Organization
Contact information
Practice address
6002 BERRYHILL RD, MILTON, FL 32570-5062
(850) 626-7762
(850) 623-5083
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/01/2026
Last updated
05/01/2026
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