Provider Demographics
NPI:1093846354
Name:METHODIST HEALTH SYSTEM FOUNDATION, INC
Entity Type:Organization
Organization Name:METHODIST HEALTH SYSTEM FOUNDATION, INC
Other - Org Name:METHODIST HEALTH SYSTEM FOUNDATION, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-726-9333
Mailing Address - Street 1:360 OAK HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5702
Mailing Address - Country:US
Mailing Address - Phone:985-726-9333
Mailing Address - Fax:985-726-2666
Practice Address - Street 1:1100 E JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-5405
Practice Address - Country:US
Practice Address - Phone:504-333-6988
Practice Address - Fax:504-342-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1039691Medicaid