Provider Demographics
NPI:1013181866
Name:NORTH CADDO HOSPITAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:NORTH CADDO HOSPITAL SERVICE DISTRICT
Other - Org Name:NCMC MEDICAL & 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:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-0792
Mailing Address - Country:US
Mailing Address - Phone:318-375-3239
Mailing Address - Fax:318-375-2755
Practice Address - Street 1:815 S PINE ST
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3314
Practice Address - Country:US
Practice Address - Phone:318-375-3239
Practice Address - Fax:318-375-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1038130Medicaid
LA1942995Medicaid
LA1942995Medicaid
LA5D072Medicare PIN
LA5B464Medicare PIN