NPIMap

Organization Active NPI

Pelican State Outpatient Center - Caro Clinic L. L. C.

Doing business as P. S. O. C. - Caro Clinic

  • Primary Care Clinic/Center
  • Gonzales, LA
National Provider Identifier
1467507913
Registry record updated Nov 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PELICAN STATE OUTPATIENT CENTER - CARO CLINIC L. L. C.
Doing business as
P. S. O. C. - Caro Clinic
Practice address
2304 S Burnside Ave Ste 2
Gonzales, LA 70737-4664
Phone
(225) 647-6533
Fax
(225) 644-7533
NPI assigned
Jan 24, 2007
Last updated
Nov 27, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2018

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

Authorized official

Name
Peter J. Monteyne, MDNPI 1043222508
Title
Member Owner
Phone
(225) 647-6533

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

2304 S Burnside Ave Ste 2
Gonzales, LA 70737-4664

Mailing address

PO Box 1499
Gonzales, LA 70707-1499
Phone (225) 647-6533

Other names 1

  • P. S. O. C. - CARO CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100628000040 LA Part B Supplier - Clinic/Group Practice 8022051234 Receives reassigned benefits from 5 practitioners
Practice locations: Baton Rouge, LA; Denham Springs, LA; Gonzales, LA

National Provider Directory

National Provider Directory

Locations

609 E Worthy St
Gonzales, LA 70737
Phone (225) 647-5526

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543276800000",
    "number": "1467507913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1499",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707071499",
            "telephone_number": "225-647-6533",
            "fax_number": "225-644-7533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 S BURNSIDE AVE STE 2",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707374664",
            "telephone_number": "225-647-6533",
            "fax_number": "225-644-7533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELICAN STATE OUTPATIENT CENTER - CARO CLINIC L. L. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2018-11-27",
        "status": "A",
        "authorized_official_last_name": "MONTEYNE",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "MEMBER OWNER",
        "authorized_official_telephone_number": "225-647-6533",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "P. S. O. C. - CARO CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "P. S. O. C. - CARO CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gonzales, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.