1770543464 NPI number — WEST CARROLL MEMORIAL HOSPITAL

Table of content: (NPI 1770543464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770543464 NPI number — WEST CARROLL MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST CARROLL MEMORIAL HOSPITAL
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:
1770543464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
706 ROSS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK GROVE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71263-9798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-428-6155
Provider Business Mailing Address Fax Number:
318-428-6172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 ROSS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK GROVE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71263-9798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-428-6155
Provider Business Practice Location Address Fax Number:
318-428-6172
Provider Enumeration Date:
03/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCIARA
Authorized Official First Name:
KELLI
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTH REP PHARM DIRECTOR
Authorized Official Telephone Number:
318-428-6252

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5244-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1272019 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112673407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1925758 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com