1932173564 NPI number — SPRINGHILL MEDICAL SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932173564 NPI number — SPRINGHILL MEDICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGHILL MEDICAL SERVICES, INC.
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:
NORTH WEBSTER MEDICAL CLINIC
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:
1932173564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 TRI-STATE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAREPTA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-994-2266
Provider Business Mailing Address Fax Number:
318-539-9177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 TRI-STATE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAREPTA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71071-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-994-2266
Provider Business Practice Location Address Fax Number:
318-539-9177
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATRONIS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
318-539-1001

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 441 RHC 3 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2165569 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 159138002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1441601 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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