Provider Demographics
NPI:1285828434
Name:DEQUINCY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DEQUINCY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-786-1200
Mailing Address - Street 1:110 WEST FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-1166
Mailing Address - Country:US
Mailing Address - Phone:337-786-1200
Mailing Address - Fax:337-786-1219
Practice Address - Street 1:110 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-3508
Practice Address - Country:US
Practice Address - Phone:337-786-1200
Practice Address - Fax:337-786-1219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEQUINCY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-30
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1796841Medicaid
LA=========0OtherBLUE CROSS