Provider Demographics
NPI:1205015955
Name:SOUTHPARK ACQUISITION COMPANY LLC
Entity Type:Organization
Organization Name:SOUTHPARK ACQUISITION COMPANY LLC
Other - Org Name:SOUTHPARK COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PROMOD
Authorized Official - Middle Name:
Authorized Official - Last Name:SETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-769-4080
Mailing Address - Street 1:314 YOUNGSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4524
Mailing Address - Country:US
Mailing Address - Phone:337-769-4080
Mailing Address - Fax:337-769-4078
Practice Address - Street 1:314 YOUNGSVILLE HWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4524
Practice Address - Country:US
Practice Address - Phone:337-769-4080
Practice Address - Fax:337-769-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1448583Medicaid
LA1729388Medicaid
LA1448583Medicaid