Provider Demographics
NPI:1477798668
Name:NORTH CADDO HOSPITAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:NORTH CADDO HOSPITAL SERVICE DISTRICT
Other - Org Name:PLAIN DEALING MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-375-4001
Mailing Address - Street 1:112 N FORREST RD
Mailing Address - Street 2:
Mailing Address - City:PLAIN DEALING
Mailing Address - State:LA
Mailing Address - Zip Code:71064-4031
Mailing Address - Country:US
Mailing Address - Phone:318-326-7272
Mailing Address - Fax:
Practice Address - Street 1:112 FOREST STREET
Practice Address - Street 2:
Practice Address - City:PLAIN DEALING
Practice Address - State:LA
Practice Address - Zip Code:71064-3446
Practice Address - Country:US
Practice Address - Phone:318-326-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02439R207Q00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2302639Medicaid
LA1444286Medicaid
LA5DH82Medicare PIN
LA193848Medicare Oscar/Certification
LA193848Medicare UPIN
LA1444286Medicaid