Provider Demographics
NPI:1366227415
Name:OPELOUSAS GENERAL HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:OPELOUSAS GENERAL HOSPITAL AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:MHA/MBA
Authorized Official - Phone:337-594-3499
Mailing Address - Street 1:539 E PRUDHOMME ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6499
Mailing Address - Country:US
Mailing Address - Phone:337-594-3499
Mailing Address - Fax:
Practice Address - Street 1:1270 ATTAKAPAS DR STE 102
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6549
Practice Address - Country:US
Practice Address - Phone:337-678-4862
Practice Address - Fax:888-571-5945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPELOUSAS GENERAL HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health