Organization
OUTPATIENT MEDICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL ISIAH WALTERS (CEO)
(318) 357-2055
Entity
Organization
Contact information
Practice address
908 S 10TH ST STE B, LEESVILLE, LA 71446
(337) 238-1274
(337) 239-2225
Mailing address
1640 BREAZEALE SPRINGS ST, NATCHITOCHES, LA 71457-4278
(318) 352-9299
(318) 352-0203
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1941026
—
LA
Enumeration date
07/03/2006
Last updated
08/29/2018
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