| Phca Houma LLC | |
|
435 Corporate Dr Ste 402 Houma LA 70360-2498 | |
| (985) 400-3019 | |
| (985) 400-3021 |
| Full Name | Phca Houma LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 435 Corporate Dr Ste 402, Houma, Louisiana |
| Authorized Official Name and Position | Wayne L Wiliams (CFO) |
| Authorized Official Contact | 2147631184 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phca Houma LLC 119 E Main St Ste 200 Lafayette LA 70501-6921 Ph: (214) 763-1184 | Phca Houma LLC 435 Corporate Dr Ste 402 Houma LA 70360-2498 Ph: (985) 400-3019 |
| NPI Number | 1356973077 |
|---|---|
| Provider Enumeration Date | 02/11/2020 |
| Last Update Date | 07/23/2020 |
| Certification Date | 07/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356973077 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| 363L00000X | Nurse Practitioner | () | Secondary |
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