# OMNICARE MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184850331
- **Authorized official:** MR. ABAYOMI R SANUSI MD (PRESIDENT)
- **Authorized official phone:** (985) 879-3600

## Contact information

- **Practice address:** 325 LIBERTY ST, HOUMA, LA 70360-4425
- **Practice address phone:** (985) 879-3600
- **Practice address fax:** (985) 879-3605
- **Mailing address:** PO BOX 981, HOUMA, LA 70361-0981
- **Mailing address phone:** (985) 879-3600
- **Mailing address fax:** (985) 879-3605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 202838 | LA | Yes |

## Other

- **Enumeration date:** 06/02/2009
- **Last updated:** 06/02/2009