Provider Demographics
NPI:1639326812
Name:SLIDELL MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SLIDELL MEMORIAL HOSPITAL
Other - Org Name:PRIMARY CARE BILLING OF SMH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-643-2200
Mailing Address - Street 1:PO BOX 1939
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-1939
Mailing Address - Country:US
Mailing Address - Phone:985-639-8970
Mailing Address - Fax:985-639-8971
Practice Address - Street 1:901 GAUSE BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2937
Practice Address - Country:US
Practice Address - Phone:985-639-8970
Practice Address - Fax:985-639-8971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care