Provider Demographics
NPI:1891126728
Name:STONEBRIDGE HEALTH SYSTEMS, LLC
Entity Type:Organization
Organization Name:STONEBRIDGE HEALTH SYSTEMS, LLC
Other - Org Name:SOUTH CAMERON MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-542-4111
Mailing Address - Street 1:5360 WEST CREOLE HWY
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:LA
Mailing Address - Zip Code:70631-8785
Mailing Address - Country:US
Mailing Address - Phone:337-542-4111
Mailing Address - Fax:337-542-4110
Practice Address - Street 1:5360 W CREOLE HWY STE 2
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:LA
Practice Address - Zip Code:70631-5127
Practice Address - Country:US
Practice Address - Phone:337-564-6770
Practice Address - Fax:337-564-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203782007207P00000X, 208M00000X
273R00000X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No273R00000XHospital UnitsPsychiatric UnitGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2700065Medicaid
LA2700057Medicaid
LA19S307Medicare PIN
LA2700057Medicaid