1609077304 NPI number — SOUTHERN REGIONAL HEALTHCARE SYSTEMS, INC.

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 1609077304 NPI number — SOUTHERN REGIONAL HEALTHCARE SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN REGIONAL HEALTHCARE SYSTEMS, 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:
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:
1609077304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2208 HIGHWAY 318
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEANERETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70544-8506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-276-6697
Provider Business Mailing Address Fax Number:
337-276-6671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 HOSPITAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70538-3724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-519-2851
Provider Business Practice Location Address Fax Number:
337-276-6671
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MATHEWS
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
ALONZO
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
337-276-6697

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X , with the licence number:  APPLIED FOR , 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)





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