Provider Demographics
NPI:1558301093
Name:SLIDELL MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SLIDELL MEMORIAL HOSPITAL
Other - Org Name:SLIDELL RADIATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BADINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-280-8503
Mailing Address - Street 1:1001 GAUSE BLVD.
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-280-2200
Mailing Address - Fax:985-649-8626
Practice Address - Street 1:1120 ROBERT BLVD. SUITE 100
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-280-8688
Practice Address - Fax:985-280-6642
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLIDELL MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA57170Medicare PIN
LA=========BOtherBLUE CROSS/BLUE SHIELD