Provider Demographics
NPI:1578632766
Name:DESOTO HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:DESOTO HOSPITAL ASSOCIATION
Other - Org Name:DESOTO REGIONAL HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-872-4610
Mailing Address - Street 1:207 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2603
Mailing Address - Country:US
Mailing Address - Phone:318-872-4610
Mailing Address - Fax:318-872-1502
Practice Address - Street 1:207 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2603
Practice Address - Country:US
Practice Address - Phone:318-872-4610
Practice Address - Fax:318-872-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19S118Medicare ID - Type UnspecifiedPSYCH