Provider Demographics
NPI:1821401241
Name:LASALLE PARISH HOSPITAL SERVICE DISTRICT #1
Entity type:Organization
Organization Name:LASALLE PARISH HOSPITAL SERVICE DISTRICT #1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-495-3131
Mailing Address - Street 1:15712 HWY 165
Mailing Address - Street 2:
Mailing Address - City:OLLA
Mailing Address - State:LA
Mailing Address - Zip Code:71465
Mailing Address - Country:US
Mailing Address - Phone:318-495-3131
Mailing Address - Fax:
Practice Address - Street 1:15712 HWY 165
Practice Address - Street 2:
Practice Address - City:URANIA
Practice Address - State:LA
Practice Address - Zip Code:71480
Practice Address - Country:US
Practice Address - Phone:318-495-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2384716Medicaid