Provider Demographics
NPI:1801843164
Name:WASH-ST TAMMANY REG MEDICAL CENTER
Entity Type:Organization
Organization Name:WASH-ST TAMMANY REG MEDICAL CENTER
Other - Org Name:BOGALUSA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-922-0775
Mailing Address - Street 1:433 PLAZA ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3729
Mailing Address - Country:US
Mailing Address - Phone:985-732-7122
Mailing Address - Fax:985-732-1257
Practice Address - Street 1:433 PLAZA ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3729
Practice Address - Country:US
Practice Address - Phone:985-732-7122
Practice Address - Fax:985-732-1257
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASH-ST TAMMANY REG MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-30
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA61048OtherBCBS PSYCH
LA1705390Medicaid
LA1705390Medicaid