Provider Demographics
NPI:1710929120
Name:SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC
Entity Type:Organization
Organization Name:SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC
Other - Org Name:MATTHEW G. SCROGGS, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-494-2094
Mailing Address - Street 1:PO BOX 122534, DEPT 2534
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:1890 W GAUTHIER RD STE 140
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7179
Practice Address - Country:US
Practice Address - Phone:337-480-5570
Practice Address - Fax:337-480-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0600010033207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4E403CU78OtherMEDICARE LEGACY
LANH4592OtherBCBS
LANH4592OtherBCBS