Provider Demographics
NPI:1225183916
Name:CATAHOULA PARISH HOSPITAL DISTRICT NO. 2
Entity Type:Organization
Organization Name:CATAHOULA PARISH HOSPITAL DISTRICT NO. 2
Other - Org Name:MEDICAL CENTER FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MIESCH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:318-389-5727
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:307 CHISUM STREET
Mailing Address - City:SICILY ISLAND
Mailing Address - State:LA
Mailing Address - Zip Code:71368-0008
Mailing Address - Country:US
Mailing Address - Phone:318-389-5727
Mailing Address - Fax:318-389-4028
Practice Address - Street 1:307 CHISUM ST
Practice Address - Street 2:
Practice Address - City:SICILY ISLAND
Practice Address - State:LA
Practice Address - Zip Code:71368-4807
Practice Address - Country:US
Practice Address - Phone:318-389-9941
Practice Address - Fax:318-389-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5539261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1940801Medicaid
LA1855391Medicaid