Organization
WOMEN'S CLINIC OF OAKDALE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEDHA M KULKARNI (ADMINISTRATOR)
(337) 468-2250
Entity
Organization
Contact information
Practice address
119 HOSPITAL DR, OAKDALE, LA 71463-3034
(318) 335-0260
(318) 335-3356
Mailing address
805 CHERRY ST, SUITE A, MAMOU, LA 70554-2223
(337) 468-2250
(337) 468-2702
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
05120R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-3898
MEDICAE PART A
—
01
—
2121014
AMERIGROUP CCN
LA
05
—
2121014
—
LA
01
—
53433DM43
GROUP MEMBER PTAN
LA
01
—
5DM43
MEDICARE PTAN
LA
Enumeration date
02/15/2010
Last updated
01/20/2015
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