Provider Demographics
NPI:1841221017
Name:NORTHSHORE REGIONAL MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:NORTHSHORE REGIONAL MEDICAL CENTER, LLC
Other - Org Name:NORTHSHORE REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-775-8043
Mailing Address - Street 1:PO BOX 676955
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-6955
Mailing Address - Country:US
Mailing Address - Phone:214-387-6444
Mailing Address - Fax:985-646-5552
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5520
Practice Address - Country:US
Practice Address - Phone:985-649-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA507282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
000451OtherHUMANA
MS00020057Medicaid
039807320OtherAETNA US HEALTHCARE (NATI
LA1744611Medicaid
190204B000000OtherSECTION 1011
60773OtherBCBS OF LOUISIANA
196086OtherCOVENTRY HEALTH CARE LOUI
MS00095306Medicaid
LA06302004Medicaid
196084OtherCOVENTRY HEALTH CARE LOUI
MS00020057Medicaid