Provider Demographics
NPI:1932173564
Name:SPRINGHILL MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:SPRINGHILL MEDICAL SERVICES, INC.
Other - Org Name:NORTH WEBSTER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATRONIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-539-1001
Mailing Address - Street 1:106 TRI-STATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAREPTA
Mailing Address - State:LA
Mailing Address - Zip Code:71071
Mailing Address - Country:US
Mailing Address - Phone:318-994-2266
Mailing Address - Fax:318-539-9177
Practice Address - Street 1:106 TRI-STATE DRIVE
Practice Address - Street 2:
Practice Address - City:SAREPTA
Practice Address - State:LA
Practice Address - Zip Code:71071-2826
Practice Address - Country:US
Practice Address - Phone:318-994-2266
Practice Address - Fax:318-539-9177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRINGHILL MEDICAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-13
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363LF0000X
LA441 RHC 3261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2165569Medicaid
AR159138002Medicaid
LA1441601Medicaid
LA1452629Medicaid
AR159138002Medicaid
LA5C817Medicare PIN
LACH7380Medicare PIN