Provider Demographics
NPI:1134126659
Name:CALDWELL MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:CALDWELL MEMORIAL HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETHERIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-649-6111
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418-0899
Mailing Address - Country:US
Mailing Address - Phone:318-649-6111
Mailing Address - Fax:318-649-5094
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418-6704
Practice Address - Country:US
Practice Address - Phone:318-649-6111
Practice Address - Fax:318-649-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA113273Y00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
90190OtherBLUE CROSS
LA1740641Medicaid
190190Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
LA1740641Medicaid