Provider Demographics
NPI:1679513600
Name:CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE
Entity Type:Organization
Organization Name:CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE
Other - Org Name:TRINITY MEDICAL FERRIDAY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NEKEISHA
Authorized Official - Middle Name:LASHAY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-719-3636
Mailing Address - Street 1:204 SERIO BLVD
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334
Mailing Address - Country:US
Mailing Address - Phone:318-757-0210
Mailing Address - Fax:318-757-9916
Practice Address - Street 1:204 SERIO BLVD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2015
Practice Address - Country:US
Practice Address - Phone:318-757-8010
Practice Address - Fax:318-757-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA247A207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2518771Medicaid
LA2100513Medicaid