1376590430 NPI number — LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1

Table of content: (NPI 1376590430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376590430 NPI number — LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1
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:
LADY OF THE SEA MEDICAL CLINIC - GOLDEN MEADOW
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:
1376590430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN MEADOW
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70357-2938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-475-5200
Provider Business Mailing Address Fax Number:
985-475-5664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDEN MEADOW
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70357-2938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-475-5200
Provider Business Practice Location Address Fax Number:
985-475-5664
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAFONT
Authorized Official First Name:
TAD
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DIRECTOR OF PRACTICE MANAGEMENT
Authorized Official Telephone Number:
985-325-9300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1459259 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5CH34 . This is a "MEDICARE PART B" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com