Morehouse Internal Medicine Clinic

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

A10630RX Issued in LA

Legal business name

MOREHOUSE INTERNAL MEDICINE CLINIC

Practice address

420 Gunby Ave
Bastrop, LA 71220-4406

Phone

(318) 812-4663

NPI assigned

Oct 3, 2011

Last updated

Oct 3, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Carlos Hernandez, PA-CNPI 1447284021

Title

Physician Assistant

Phone

(318) 812-4663

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carlos Hernandez, PA-C

  • Medical Physician Assistant
  • Bastrop, LA
  • NPI 1447284021
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317600000000",
    "number": "1063796571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 GUNBY AVE",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 GUNBY AVE",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204406",
            "telephone_number": "318-812-4663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOREHOUSE INTERNAL MEDICINE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-03",
        "last_updated": "2011-10-03",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "318-812-4663",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "A10630RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1625892",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morehouse General Hospital
• Morehouse General Hospital
• Morehouse General Hospital (Morehouse Family Medicine Rural Health Clinic)
• Morehouse Hosp. Women's Health Center
• Morehouse Hyperbaric Medicine Providers, LLC
• Morehouse Parish Dialysis Center, LLC (Morehouse Parish Dialysis Center)
• Morehouse Parish Hospital Service District (Morehouse General Hospital Anesthesia)
• Morehouse Parish Hospital Service District 1 (MGH Physicians Clinic)
• Morehouse Parish School Board
• Morehouse Parish School Board

• Medical Physician Assistant in Bastrop, LA
• Providers in Bastrop, LA by specialty
• Medical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.