Provider Demographics
NPI:1215076302
Name:OPTIMAL HEALTH OUTPATIENT CLINIC
Entity type:Organization
Organization Name:OPTIMAL HEALTH OUTPATIENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEBOYE
Authorized Official - Middle Name:ADELAJA
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-932-9150
Mailing Address - Street 1:7240 RENOIR AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-2259
Mailing Address - Country:US
Mailing Address - Phone:225-932-9150
Mailing Address - Fax:225-932-9149
Practice Address - Street 1:7240 RENOIR AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2259
Practice Address - Country:US
Practice Address - Phone:225-932-9150
Practice Address - Fax:225-932-9149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13264R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447579Medicaid
LAH05183Medicare UPIN
LA5CP30Medicare ID - Type UnspecifiedGROUP NUMBER