1407046246 NPI number — DOCTORS' HOSPITAL AT DEER CREEK, LLC

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 1407046246 NPI number — DOCTORS' HOSPITAL AT DEER CREEK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS' HOSPITAL AT DEER CREEK, LLC
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:
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:
1407046246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 S 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71446-4611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-392-5088
Provider Business Mailing Address Fax Number:
337-238-9691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 SOUTH 10TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-274-1102
Provider Business Practice Location Address Fax Number:
504-832-2116
Provider Enumeration Date:
07/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE DIRECTOR
Authorized Official Telephone Number:
337-419-0735

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1702315 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61462 . This is a "BCBS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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