Provider Demographics
NPI:1396911574
Name:CALDWELL MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:CALDWELL MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETHERIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-724-6789
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418-0899
Mailing Address - Country:US
Mailing Address - Phone:318-649-6111
Mailing Address - Fax:318-649-5094
Practice Address - Street 1:3286 OAK ST
Practice Address - Street 2:
Practice Address - City:WISNER
Practice Address - State:LA
Practice Address - Zip Code:71378
Practice Address - Country:US
Practice Address - Phone:318-724-6789
Practice Address - Fax:318-724-6788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALDWELL MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-07
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1408743Medicaid
LA193471OtherMEDICARE PROVIDER #