Provider Demographics
NPI:1003310756
Name:NORTH CADDO HOSPITAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:NORTH CADDO HOSPITAL SERVICE DISTRICT
Other - Org Name:NCMC MEDICAL AND SURGICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAKOTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-375-4097
Mailing Address - Street 1:815 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-3353
Mailing Address - Country:US
Mailing Address - Phone:318-375-4007
Mailing Address - Fax:
Practice Address - Street 1:815 S PINE ST
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3353
Practice Address - Country:US
Practice Address - Phone:318-375-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CADDO HOSPITAL SERVICE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-19
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1038130Medicaid