1275852303 NPI number — CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE

Table of content: (NPI 1275852303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275852303 NPI number — CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE
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:
TRINITY MEDICAL
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:
1275852303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERRIDAY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71334-0111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-757-6551
Provider Business Mailing Address Fax Number:
318-757-8610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6569 HIGHWAY 84
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERRIDAY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71334-4573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-757-6551
Provider Business Practice Location Address Fax Number:
318-757-6832
Provider Enumeration Date:
05/28/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
NEKEISHA
Authorized Official Middle Name:
LASHAY
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
318-719-3636

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  247 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 247 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1732231 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".