Provider Demographics
NPI:1932256542
Name:LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1
Entity Type:Organization
Organization Name:LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1
Other - Org Name:LADY OF THE SEA MEDICAL CLINIC - LAROSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF CLINIC OFFCIER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAFONT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:985-632-6401
Mailing Address - Street 1:13030 HIGHWAY 308
Mailing Address - Street 2:
Mailing Address - City:LAROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70373-2056
Mailing Address - Country:US
Mailing Address - Phone:985-798-7000
Mailing Address - Fax:985-798-7021
Practice Address - Street 1:13030 HIGHWAY 308
Practice Address - Street 2:
Practice Address - City:LAROSE
Practice Address - State:LA
Practice Address - Zip Code:70345-4143
Practice Address - Country:US
Practice Address - Phone:985-798-7000
Practice Address - Fax:985-798-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1457671Medicaid
LA1457671Medicaid