Provider Demographics
NPI:1053575043
Name:MADISON PARISH HOSPITAL SERVICE DISTRICT
Entity type:Organization
Organization Name:MADISON PARISH HOSPITAL SERVICE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:SATIRA
Authorized Official - Middle Name:T
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-574-5080
Mailing Address - Street 1:808 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-4535
Mailing Address - Country:US
Mailing Address - Phone:318-574-3575
Mailing Address - Fax:318-574-5052
Practice Address - Street 1:900 JOHNSON ST STE A
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-4537
Practice Address - Country:US
Practice Address - Phone:318-574-3575
Practice Address - Fax:318-574-5052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADISON PARISH HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA143-RHC-2261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2112023Medicaid
LA193477Medicare PIN