Provider Demographics
NPI:1083793582
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:ST TAMMANY PHYSICIANS NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-898-4000
Mailing Address - Street 1:PO BOX 669379
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-9379
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 GARDENIA DR
Practice Address - Street 2:SUITE B
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-9168
Practice Address - Country:US
Practice Address - Phone:985-871-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST TAMMANY PARISH HOSPITAL SERVICE DISTRICT NO 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1942618Medicaid
5D347Medicare ID - Type Unspecified
5D347Medicare ID - Type Unspecified