1972549855 NPI number — SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC

Table of content: (NPI 1972549855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972549855 NPI number — SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION 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:
LAKE CHARLES MEMORIAL 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:
1972549855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 OAK PARK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70601-8911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-494-3000
Provider Business Mailing Address Fax Number:
337-494-2947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 OAK PARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-8911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-494-3000
Provider Business Practice Location Address Fax Number:
337-494-2947
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFIER
Authorized Official Telephone Number:
337-494-2094

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  112 , 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: 0002 . This is a "CHAMPUS ACUTE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 0073977 . This is a "AETNA - ALL" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 0020349 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10494 . This is a "BCBS MEDICAL STAFF" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 90060 . This is a "BCBS ACUTE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 04774 . This is a "BCBS ER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1796794 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1720461 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP41087 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190060 . This is a "TX WORK COMP CARRIERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 375150400 . This is a "DEPT OF LABOR" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 112 . This is a "DHH LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 130043603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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