Basic Information
| Provider Information | |||||||||
| NPI: | 1366684201 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCEANS PHYSICIANS GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 W BROAD ST | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706014291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3377211900 | ||||||||
| FaxNumber: | 3377211996 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 HEATHER DR | ||||||||
| Address2: | |||||||||
| City: | OPELOUSAS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705707714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379488820 | ||||||||
| FaxNumber: | 3479488821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2009 | ||||||||
| LastUpdateDate: | 03/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 3377211900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.