Provider Demographics
NPI:1043715089
Name:ST TAMMANY PARISH HOSPITAL SERVICE DISTRICT NO 1
Entity Type:Organization
Organization Name:ST TAMMANY PARISH HOSPITAL SERVICE DISTRICT NO 1
Other - Org Name:M & W COVINGTON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AVP LEGAL AFFAIRS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLEIGH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:985-871-5830
Mailing Address - Street 1:1107 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2327
Mailing Address - Country:US
Mailing Address - Phone:985-871-5830
Mailing Address - Fax:985-892-2742
Practice Address - Street 1:1107 S TYLER ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2327
Practice Address - Country:US
Practice Address - Phone:985-892-0818
Practice Address - Fax:985-892-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.007668-IR3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176886OtherPK
LA2206214Medicaid