1093834608 NPI number — MADISON PARISH HOSPITAL SERVICE DISTRICT

Table of content: (NPI 1093834608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093834608 NPI number — MADISON PARISH HOSPITAL SERVICE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADISON PARISH HOSPITAL SERVICE DISTRICT
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:
MADISON PARISH 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:
1093834608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1559
Provider Second Line Business Mailing Address:
900 JOHNSON STREET
Provider Business Mailing Address City Name:
TALLULAH
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71284-1559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-574-2374
Provider Business Mailing Address Fax Number:
318-574-2396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 JOHNSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLULAH
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71282-4537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-574-2374
Provider Business Practice Location Address Fax Number:
318-574-2396
Provider Enumeration Date:
03/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TOPOLEWSKI
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO ADMINISTRATOR
Authorized Official Telephone Number:
318-574-2374

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  143 , 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: 1797511 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60010 . This is a "BLUE CROSS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".