OUTPATIENT MEDICAL CENTER, INC. (NPI# 1750311064) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750311064 |
| Entity Type | Organization |
| Organization Name | OUTPATIENT MEDICAL CENTER, INC. |
| Practice Address |
804 N Beech St Tallulah LA 71282 |
| Mailing Address |
1640 Breazeale Springs St Natchitoches LA 71457-4278 |
| Practice Telephone | 3185741453 |
| Practice Fax Number | 3185745876 |
| Mailing Telephone | 3183529299 |
| Mailing Fax Number | 3183520203 |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2018-08-29 |
| Authorized Official Name | CARL ISIAH WALTERS II (CEO) |
| Authorized Official Telephone | 3183572055 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | Dental Providers | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1941042 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578107769 | Outpatient Medical Center, Inc. | Clinic/Center | 1621 Welch St, Natchitoches, LA 71457-4264 | 2019-10-31 |
| 1013551100 | Outpatient Medical Center, Inc. | Clinic/Center | 520 Saint Maurice Ln, Natchitoches, LA 71457-6199 | 2019-10-31 |
| 1457753709 | Outpatient Medical Center, Inc. | Clinic/Center | 800 Koonce St, Natchitoches, LA 71457-3416 | 2014-09-18 |
| 1285664508 | Outpatient Medical Center, Inc. | Dentist | 908 S 10th St Ste B, Leesville, LA 71446 | 2006-07-03 |
| 1750925947 | Outpatient Medical Center, Inc. | Clinic/Center | 1001 E 5th St, Natchitoches, LA 71457-5203 | 2019-10-31 |
| 1154832434 | Outpatient Medical Center, Inc. | Clinic/Center | 1500 Gold St, Natchitoches, LA 71457-4221 | 2017-10-13 |
| 1871523266 | Outpatient Medical Center, Inc. | Dentist | 1640 Breazeale Springs St, Natchitoches, LA 71457 | 2006-07-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | OUTPATIENT MEDICAL CENTER, INC. | 1640 Breazeale Springs St, Natchitoches, LA 71457-4278 |
| Street Address |
804 N BEECH ST |
| City | TALLULAH |
| State | LA |
| Zip Code | 71282 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457314494 | Ronald C. Wyche | Family Medicine | 804 N Beech St, Tallulah, LA 71282-3809 | 2006-04-10 |
| 1871149252 | Tori Lynette Walker | Family Medicine | 804 N Beech St, Tallulah, LA 71282-3809 | 2019-08-12 |
| 1699236794 | Karrah Clark | Nurse Practitioner | 804 N Beech St, Tallulah, LA 71282-3809 | 2019-03-29 |
| 1609198308 | Don C Williams | Dentist | 804 N Beech St, Tallulah, LA 71282-3809 | 2010-02-22 |
| 1023036381 | Kathy G Corbin | Nurse Practitioner | 804 N Beech St, Tallulah, LA 71282-3809 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982211140 | Adonis Williams | Counselor | 410 E Askew Street, Tallulah, LA 71282 | 2020-09-30 |
| 1154957272 | Renewed Path Counseling Services LLC | Community/Behavioral Health | 602 Wood St Suite A, Richmond, LA 71282 | 2020-03-20 |
| 1639632136 | Ljconsulting & Professional Services, LLC | Counselor | 809 Bailey Rd., Tallulah, LA 71282 | 2019-04-11 |
| 1982120937 | Chryl Smith Lee | Counselor | 1705 W Feliciana Ave, Talullah, LA 71282 | 2017-08-21 |
| 1730619347 | Carmen Larae Allen | Counselor | 805 N Beech Street, Tallulah, LA 71282 | 2017-06-15 |
| 1205365665 | Brittney Vontres Scott | Case Manager/Care Coordinator | 1705 Felicia Avenue, Tallulah, LA 71282 | 2017-06-08 |
| 1427500123 | Sharon Jackson | Case Manager/Care Coordinator | 1000 S Elm St, Tallulah, LA 71282 | 2016-10-28 |
| 1982152989 | John Tanner Mcdonald | Pharmacist | 402 East Darrow Street, Tallulah, LA 71282 | 2016-09-19 |
| 1164874350 | Victor Lewis Jr. | Counselor | 1705 Felicia Drive, Tallulah, LOUISIANA 71282 | 2016-07-12 |
| 1356797492 | Keisha Prosser | Case Manager/Care Coordinator | 1705 Felicia Aveune, Tallulah, LA 71282 | 2016-05-08 |
| Find all providers in zip 71282 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1669086690 | Marillac Community Health Centers | Clinic/Center | 1908 Short St, Kenner, LA 70062-7550 | 2020-09-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.