Provider Demographics
NPI:1407175615
Name:ST. MARTIN HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST. MARTIN HOSPITAL, INC.
Other - Org Name:ST. MARTIN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-332-2178
Mailing Address - Street 1:210 CHAMPAGNE BLVD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-3700
Mailing Address - Country:US
Mailing Address - Phone:337-332-2178
Mailing Address - Fax:337-332-5092
Practice Address - Street 1:210 CHAMPAGNE BLVD
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3700
Practice Address - Country:US
Practice Address - Phone:337-332-2178
Practice Address - Fax:337-332-5092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1799785Medicaid
LA18170OtherBCBS
LA18170OtherBCBS