Provider Demographics
NPI:1003113085
Name:WOMEN & CHILDREN'S HOSPITAL LLC
Entity Type:Organization
Organization Name:WOMEN & CHILDREN'S HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:PO BOX 848415
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8415
Mailing Address - Country:US
Mailing Address - Phone:337-475-4140
Mailing Address - Fax:866-288-5449
Practice Address - Street 1:4200 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4118
Practice Address - Country:US
Practice Address - Phone:337-474-6370
Practice Address - Fax:337-475-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA818787133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPENDINGMedicare PIN