Provider Demographics
NPI:1437482817
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:AUTHORIZED DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALLECOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-289-7374
Mailing Address - Street 1:210 CHAMPAGNE BOULEVARD
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 BOULEVARD
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:2009-09-16
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1734730Medicaid
LA61561OtherBCBS
LA61561OtherBCBS