Provider Demographics
NPI:1699191999
Name:SPRINGHILL MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:SPRINGHILL MEDICAL SERVICES, INC.
Other - Org Name:MUDDY BOTTOMS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SEDMINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-539-1001
Mailing Address - Street 1:2001 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGHILL
Mailing Address - State:LA
Mailing Address - Zip Code:71075-4526
Mailing Address - Country:US
Mailing Address - Phone:318-539-1000
Mailing Address - Fax:318-539-4085
Practice Address - Street 1:369 MUDDY BOTTOMS DRIVE
Practice Address - Street 2:
Practice Address - City:SAREPTA
Practice Address - State:LA
Practice Address - Zip Code:71071
Practice Address - Country:US
Practice Address - Phone:318-539-1000
Practice Address - Fax:318-539-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA441261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
19-0088Medicare PIN
5C817Medicare PIN