Provider Demographics
NPI:1164738126
Name:ST CHARLES PARISH HOSPITAL
Entity Type:Organization
Organization Name:ST CHARLES PARISH HOSPITAL
Other - Org Name:ST CHARLES PARISH HOSPITAL MEDICAL STAFF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-785-6242
Mailing Address - Street 1:1057 PAUL MAILLARD RD
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-4349
Mailing Address - Country:US
Mailing Address - Phone:985-785-6242
Mailing Address - Fax:985-785-3686
Practice Address - Street 1:1057 PAUL MAILLARD RD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4349
Practice Address - Country:US
Practice Address - Phone:985-785-6242
Practice Address - Fax:985-785-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA151208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LANJ0797OtherBLUE CROSS BLUE SHEILD
LA04845OtherBLUE CROSS BLUE SHIELD