Provider Demographics
NPI:1750614277
Name:DOCTORS HOSPITAL AT DEER CREEK LLC
Entity type:Organization
Organization Name:DOCTORS HOSPITAL AT DEER CREEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-392-5088
Mailing Address - Street 1:PO BOX 1391
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71496-1391
Mailing Address - Country:US
Mailing Address - Phone:337-392-5088
Mailing Address - Fax:337-392-4982
Practice Address - Street 1:815 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4611
Practice Address - Country:US
Practice Address - Phone:337-392-5088
Practice Address - Fax:337-392-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA628282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPENDINGMedicaid
LAPENDINGMedicaid