Provider Demographics
NPI:1437395456
Name:RURAL HEALTHCARE DEVELOPERS OF LOUISIANA LLC
Entity Type:Organization
Organization Name:RURAL HEALTHCARE DEVELOPERS OF LOUISIANA LLC
Other - Org Name:SOUTH CAMERON MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-321-1155
Mailing Address - Street 1:5360 W CREOLE HWY
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:LA
Mailing Address - Zip Code:70631-5127
Mailing Address - Country:US
Mailing Address - Phone:337-542-4111
Mailing Address - Fax:337-542-4110
Practice Address - Street 1:5360 W CREOLE HWY
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:LA
Practice Address - Zip Code:70631-5127
Practice Address - Country:US
Practice Address - Phone:337-542-4111
Practice Address - Fax:337-542-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA534282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1732095Medicaid
LA1732095Medicaid