1083661409 NPI number — LALLIE KEMP MEDICAL CTR

Table of content: (NPI 1083661409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083661409 NPI number — LALLIE KEMP MEDICAL CTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LALLIE KEMP MEDICAL CTR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LALLIE KEMP REGIONAL MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083661409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52579 HIGHWAY 51 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70443-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-878-9421
Provider Business Mailing Address Fax Number:
985-878-1263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52579 HIGHWAY 51 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70443-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-878-9421
Provider Business Practice Location Address Fax Number:
985-878-1263
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
K
Authorized Official Title or Position:
ACTING CEO
Authorized Official Telephone Number:
225-922-0775

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1720411 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90010 . This is a "BCBS ACUTE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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