Provider Demographics
NPI:1528379864
Name:MADISON PARISH HOSPITAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:MADISON PARISH HOSPITAL SERVICE DISTRICT
Other - Org Name:MADISON PARISH HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPOLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMH
Authorized Official - Phone:318-651-5601
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:900 JOHNSON STREET
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71284-1559
Mailing Address - Country:US
Mailing Address - Phone:318-574-2374
Mailing Address - Fax:318-574-2396
Practice Address - Street 1:900 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-4537
Practice Address - Country:US
Practice Address - Phone:318-574-2374
Practice Address - Fax:318-574-2396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA143282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1720119Medicaid
LA60010OtherBLUE CROSS
5D124Medicare UPIN
LA1720119Medicaid
191314Medicare Oscar/Certification