Provider Demographics
NPI:1851581896
Name:OUR LADY OF LOURDES REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:OUR LADY OF LOURDES REGIONAL MEDICAL CENTER
Other - Org Name:KELLY T CAHILL JR MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-470-4380
Mailing Address - Street 1:3220 KALISTE SALOOM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7422
Mailing Address - Country:US
Mailing Address - Phone:337-406-9474
Mailing Address - Fax:337-406-1027
Practice Address - Street 1:3220 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7422
Practice Address - Country:US
Practice Address - Phone:337-406-9474
Practice Address - Fax:337-406-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200283261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1075736Medicaid