Provider Demographics
NPI:1073641866
Name:WASHINGTON ST. TAMMANY REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:WASHINGTON ST. TAMMANY REGIONAL MEDICAL CENTER
Other - Org Name:BOGALUSA MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE CHANCELLOR CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITHBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-922-1474
Mailing Address - Street 1:433 PLAZA ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3729
Mailing Address - Country:US
Mailing Address - Phone:985-732-7122
Mailing Address - Fax:
Practice Address - Street 1:1403 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-4428
Practice Address - Country:US
Practice Address - Phone:985-732-7122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447706Medicaid