Provider Demographics
NPI:1407414816
Name:ST. MARTIN HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST. MARTIN HOSPITAL, INC.
Other - Org Name:ST. MARTIN HOSPITAL COMMUNITY HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WYBLE
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:337-507-1201
Mailing Address - Fax:
Practice Address - Street 1:1555 GARY DR STE C
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3448
Practice Address - Country:US
Practice Address - Phone:337-909-2460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARTIN HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-31
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health