Provider Demographics
NPI:1083661409
Name:LALLIE KEMP MEDICAL CTR
Entity Type:Organization
Organization Name:LALLIE KEMP MEDICAL CTR
Other - Org Name:LALLIE KEMP REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-922-0775
Mailing Address - Street 1:52579 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:70443-2231
Mailing Address - Country:US
Mailing Address - Phone:985-878-9421
Mailing Address - Fax:985-878-1263
Practice Address - Street 1:52579 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-2231
Practice Address - Country:US
Practice Address - Phone:985-878-9421
Practice Address - Fax:985-878-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1720411Medicaid
LA90010OtherBCBS ACUTE
LA191321Medicare Oscar/Certification