1164687307 NPI number — CHRISTUS HEALTH CENTRAL LOUISIANA

Table of content: (NPI 1164687307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164687307 NPI number — CHRISTUS HEALTH CENTRAL LOUISIANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTUS HEALTH CENTRAL LOUISIANA
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:
Provider Other Organization Name Type Code:
6
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:
1164687307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3330 MASONIC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71301-3841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-483-4031
Provider Business Mailing Address Fax Number:
318-483-4044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 CHERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVENCAL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-472-8660
Provider Business Practice Location Address Fax Number:
318-472-8661
Provider Enumeration Date:
07/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
MONTE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
337-470-2100

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X , with the licence number:  234 , 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: 1808814 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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