Provider Demographics
NPI:1548398852
Name:LASALLE HOSPITAL SERVICE DISTRICT #1
Entity Type:Organization
Organization Name:LASALLE HOSPITAL SERVICE DISTRICT #1
Other - Org Name:HARDTNER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUPPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-495-3131
Mailing Address - Street 1:1102 N PINE RD
Mailing Address - Street 2:
Mailing Address - City:OLLA
Mailing Address - State:LA
Mailing Address - Zip Code:71465-4804
Mailing Address - Country:US
Mailing Address - Phone:318-495-3131
Mailing Address - Fax:318-495-3229
Practice Address - Street 1:1102 N PINE RD
Practice Address - Street 2:
Practice Address - City:OLLA
Practice Address - State:LA
Practice Address - Zip Code:71465-4804
Practice Address - Country:US
Practice Address - Phone:318-495-3131
Practice Address - Fax:318-495-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA178283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1705926Medicaid