Provider Demographics
NPI:1790183820
Name:ST JAMES PARISH HOSP SERV DIST
Entity Type:Organization
Organization Name:ST JAMES PARISH HOSP SERV DIST
Other - Org Name:SJPH PHYSICIAN CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-258-5900
Mailing Address - Street 1:1645 LUTCHER AVE
Mailing Address - Street 2:
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-5150
Mailing Address - Country:US
Mailing Address - Phone:225-258-5906
Mailing Address - Fax:225-869-5271
Practice Address - Street 1:1645 LUTCHER AVE
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5150
Practice Address - Country:US
Practice Address - Phone:225-258-5906
Practice Address - Fax:225-869-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty