Provider Demographics
NPI:1932246378
Name:DESOTO HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:DESOTO HOSPITAL ASSOCIATION
Other - Org Name:DESOTO REGIONAL HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-270-3250
Mailing Address - Street 1:2026 OBRIE STREET
Mailing Address - Street 2:PO BOX 1339
Mailing Address - City:ZWOLLE
Mailing Address - State:LA
Mailing Address - Zip Code:71486-1339
Mailing Address - Country:US
Mailing Address - Phone:318-645-6013
Mailing Address - Fax:
Practice Address - Street 1:2026 OBRIE STREET
Practice Address - Street 2:
Practice Address - City:ZWOLLE
Practice Address - State:LA
Practice Address - Zip Code:71486-1339
Practice Address - Country:US
Practice Address - Phone:318-645-6013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESOTO HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA193449OtherMEDICARE
LA1447242Medicaid