Provider Demographics
NPI:1619098498
Name:MADISON HIGH SBHC
Entity Type:Organization
Organization Name:MADISON HIGH SBHC
Other - Org Name:REUBEN MCCALL SCHOOL BASED HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:APNP
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:FARRISH
Authorized Official - Last Name:REDD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:318-574-5371
Mailing Address - Street 1:900 WYCHE ST
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282
Mailing Address - Country:US
Mailing Address - Phone:318-574-5371
Mailing Address - Fax:318-574-5345
Practice Address - Street 1:301 S. CHESTNUT
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282
Practice Address - Country:US
Practice Address - Phone:318-574-5371
Practice Address - Fax:318-574-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1446343Medicaid
LA1316288Medicaid
LA1101486Medicaid