Provider Demographics
NPI:1275694804
Name:STANOCOLA EMPLOYEES MEDICAL AND HOSPITAL ASSOCIATION, INC
Entity Type:Organization
Organization Name:STANOCOLA EMPLOYEES MEDICAL AND HOSPITAL ASSOCIATION, INC
Other - Org Name:STANOCOLA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEDOUX
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASTANT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:225-952-8530
Mailing Address - Street 1:16777 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3254
Mailing Address - Country:US
Mailing Address - Phone:225-926-7200
Mailing Address - Fax:225-952-8502
Practice Address - Street 1:16777 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3254
Practice Address - Country:US
Practice Address - Phone:225-926-7200
Practice Address - Fax:225-952-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1943118Medicaid
LA5F900Medicare ID - Type Unspecified