Provider Demographics
NPI:1023557113
Name:ST. MARTIN HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST. MARTIN HOSPITAL, INC.
Other - Org Name:ST. MARTIN HOSPITAL SPECIALTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALLECOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-289-7374
Mailing Address - Street 1:210 CHAMPAGNE BLVD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-3700
Mailing Address - Country:US
Mailing Address - Phone:337-442-6506
Mailing Address - Fax:
Practice Address - Street 1:225 CHAMPAGNE BLVD
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3700
Practice Address - Country:US
Practice Address - Phone:337-442-6506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAFAYETTE GENERAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA240282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access