Provider Demographics
NPI:1710975545
Name:OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL
Other - Org Name:ASSUMPTION COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:P
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-526-0013
Mailing Address - Street 1:135 HIGHWAY 402
Mailing Address - Street 2:
Mailing Address - City:NAPOLEONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70390-2217
Mailing Address - Country:US
Mailing Address - Phone:985-369-3600
Mailing Address - Fax:
Practice Address - Street 1:135 HIGHWAY 402
Practice Address - Street 2:
Practice Address - City:NAPOLEONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70390-2217
Practice Address - Country:US
Practice Address - Phone:985-369-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19-3426Medicare ID - Type UnspecifiedPROVIDER NUMBER