Provider Demographics
NPI:1518106962
Name:HUEY P. LONG REG MEDICAL CENTER
Entity Type:Organization
Organization Name:HUEY P. LONG REG MEDICAL CENTER
Other - Org Name:HUEY P. LONG CRNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SOTAK
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:318-675-7737
Mailing Address - Street 1:352 HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-0000
Mailing Address - Country:US
Mailing Address - Phone:318-448-0811
Mailing Address - Fax:318-473-6360
Practice Address - Street 1:352 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71361-5352
Practice Address - Country:US
Practice Address - Phone:318-448-0811
Practice Address - Fax:318-473-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA255367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1799947Medicaid
LA57595Medicare PIN