1841221017 NPI number — NORTHSHORE REGIONAL MEDICAL CENTER, LLC

Table of content: (NPI 1841221017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841221017 NPI number — NORTHSHORE REGIONAL MEDICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHSHORE REGIONAL MEDICAL CENTER, LLC
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:
NORTHSHORE 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:
1841221017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 676955
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-6955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-387-6444
Provider Business Mailing Address Fax Number:
985-646-5552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MEDICAL CENTER DR
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:
70461-5520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-649-7070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMIN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VP OF GOVT PROGRAMS, TENET
Authorized Official Telephone Number:
310-775-8043

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  507 , 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: 000451 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00020057 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 039807320 . This is a "AETNA US HEALTHCARE (NATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1744611 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190204B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60773 . This is a "BCBS OF LOUISIANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 196086 . This is a "COVENTRY HEALTH CARE LOUI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00095306 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06302004 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196084 . This is a "COVENTRY HEALTH CARE LOUI" identifier . This identifiers is of the category "OTHER".




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