1114976263 NPI number — SLIDELL MEMORIAL HOSPITAL

Table of content: (NPI 1114976263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114976263 NPI number — SLIDELL MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLIDELL MEMORIAL HOSPITAL
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:
MD IMAGING SLIDELL
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:
1114976263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 GAUSE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70458-2939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-643-2200
Provider Business Mailing Address Fax Number:
985-649-8626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1495 GAUSE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70458-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-405-5200
Provider Business Practice Location Address Fax Number:
985-405-5201
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
BILL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
985-649-8504

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  156 , 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: 09077321 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1448516 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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