Provider Demographics
NPI:1053415745
Name:LASALLE PARISH HOSPITAL SERVICE DISTRICT #1
Entity type:Organization
Organization Name:LASALLE PARISH HOSPITAL SERVICE DISTRICT #1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-495-3131
Mailing Address - Street 1:1049 N PINE RD
Mailing Address - Street 2:
Mailing Address - City:OLLA
Mailing Address - State:LA
Mailing Address - Zip Code:71465-4826
Mailing Address - Country:US
Mailing Address - Phone:318-495-3880
Mailing Address - Fax:318-495-0773
Practice Address - Street 1:1049 NORTH PINE ROAD
Practice Address - Street 2:
Practice Address - City:OLLA
Practice Address - State:LA
Practice Address - Zip Code:71465
Practice Address - Country:US
Practice Address - Phone:318-495-3880
Practice Address - Fax:318-495-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA178RHC-1261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1449342Medicaid
LA5CS75Medicare PIN
LA4K008CS75Medicare UPIN
193456Medicare ID - Type Unspecified