Provider Demographics
NPI:1114976263
Name:SLIDELL MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SLIDELL MEMORIAL HOSPITAL
Other - Org Name:MD IMAGING SLIDELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-649-8504
Mailing Address - Street 1:1001 GAUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2939
Mailing Address - Country:US
Mailing Address - Phone:985-643-2200
Mailing Address - Fax:985-649-8626
Practice Address - Street 1:1495 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2205
Practice Address - Country:US
Practice Address - Phone:985-405-5200
Practice Address - Fax:985-405-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA156282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09077321Medicaid
LA1448516Medicaid
LA1448516Medicaid
LA5DA22Medicare PIN