Provider Demographics
NPI:1174664833
Name:PACER HEALTH MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:PACER HEALTH MANAGEMENT CORPORATION
Other - Org Name:SOUTH CAMERON MEMORIAL LONGTERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-840-0196
Mailing Address - Street 1:5360 WEST CREOLE HWY
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:LA
Mailing Address - Zip Code:70631-5127
Mailing Address - Country:US
Mailing Address - Phone:337-542-4111
Mailing Address - Fax:337-542-4110
Practice Address - Street 1:5360 WEST CREOLE HWY
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:LA
Practice Address - Zip Code:70631-5127
Practice Address - Country:US
Practice Address - Phone:337-542-4111
Practice Address - Fax:337-542-4110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACER HEALTH MANAGEMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-08
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA534275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1510874Medicaid
LA30985OtherBCBS
LA30985OtherBLUE CROSS
LA30985OtherBCBS
LA19U037Medicare UPIN
19U037Medicare Oscar/Certification