Provider Demographics
NPI:1881800761
Name:NORTHWOOD MEDICAL CENTER
Entity type:Organization
Organization Name:NORTHWOOD MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENSON
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRIGSBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-254-2892
Mailing Address - Street 1:2916 N. TRENTON ST.
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2444
Mailing Address - Country:US
Mailing Address - Phone:318-254-2892
Mailing Address - Fax:318-254-2898
Practice Address - Street 1:2916 N. TRENTON ST.
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2444
Practice Address - Country:US
Practice Address - Phone:318-254-2892
Practice Address - Fax:318-254-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018222261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA018222OtherMEDICAL LICENSE NUMBER
LA018222OtherMEDICAL LICENSE NUMBER
5BC79Medicare PIN
LA018222OtherMEDICAL LICENSE NUMBER