1356306971 NPI number — IASIS OUACHITA COMMUNITY HOSPITAL LP

Table of content: DR. CARMEN CANEDA-D'AMBROSI PH.D. (NPI 1083867790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356306971 NPI number — IASIS OUACHITA COMMUNITY HOSPITAL LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IASIS OUACHITA COMMUNITY HOSPITAL LP
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:
OUACHITA COMMUNITY HOSPITAL
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:
1356306971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 SEABOARD LN BLDG E
Provider Second Line Business Mailing Address:
ATTN: IASIS CORPORATE LEGAL DEPARTMENT
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-2855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-844-2747
Provider Business Mailing Address Fax Number:
615-467-1271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 GLENWOOD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71291-5539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-322-1339
Provider Business Practice Location Address Fax Number:
318-322-1693
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
318-329-4200

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  633 , 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: 167873105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1703311 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61470 . This is a "BCBS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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