1578568481 NPI number — SLIDELL MEMORIAL HOSPITAL

Table of content: (NPI 1578568481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578568481 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:
ST TAMMANY PARISH HOSPITAL SERVICE DISTRICT #2
Provider Other Organization Name Type Code:
4
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:
1578568481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2024
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:
70458-2987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-643-2200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 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:
70458-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-643-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BADINGER
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
985-280-2200

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: 1720313 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00020424 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018398800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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