Provider Demographics
NPI:1619469202
Name:ST MARTIN HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST MARTIN HOSPITAL, INC.
Other - Org Name:ST. MARTIN HOSPITAL SPECIALTY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VP COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-289-8684
Mailing Address - Street 1:920 W PINHOOK RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2455
Mailing Address - Country:US
Mailing Address - Phone:337-289-8684
Mailing Address - Fax:
Practice Address - Street 1:1555 GARY DR STE A
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3448
Practice Address - Country:US
Practice Address - Phone:337-909-2474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARTIN HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-31
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA672261QM2500X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA61561OtherBLUE CROSS BLUE SHIELD