Provider Demographics
NPI:1407046246
Name:DOCTORS' HOSPITAL AT DEER CREEK, LLC
Entity Type:Organization
Organization Name:DOCTORS' HOSPITAL AT DEER CREEK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-419-0735
Mailing Address - Street 1:815 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4611
Mailing Address - Country:US
Mailing Address - Phone:337-392-5088
Mailing Address - Fax:337-238-9691
Practice Address - Street 1:815 SOUTH 10TH STREET
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446
Practice Address - Country:US
Practice Address - Phone:504-274-1102
Practice Address - Fax:504-832-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1702315Medicaid
LA61462OtherBCBS
LA61462OtherBCBS