Provider Demographics
NPI:1548322365
Name:MORGAN CITY ORTHOPEDIC CLINIC
Entity type:Organization
Organization Name:MORGAN CITY ORTHOPEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:FITTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-384-7900
Mailing Address - Street 1:PO BOX 2375
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70381
Mailing Address - Country:US
Mailing Address - Phone:985-384-7900
Mailing Address - Fax:985-384-8049
Practice Address - Street 1:1234 DAVID DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380
Practice Address - Country:US
Practice Address - Phone:985-384-7900
Practice Address - Fax:985-384-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL04053R302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1175731Medicaid
LA51641Medicare ID - Type Unspecified
LA1175731Medicaid