Provider Demographics
NPI:1952428450
Name:HOSPITAL SERVICE DISTRICT NO. 1 OF THE PARISH OF VERMILION
Entity Type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT NO. 1 OF THE PARISH OF VERMILION
Other - Org Name:ABROM KAPLAN MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEBODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-643-5200
Mailing Address - Street 1:1310 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-2910
Mailing Address - Country:US
Mailing Address - Phone:337-643-8300
Mailing Address - Fax:337-643-5233
Practice Address - Street 1:1310 W 7TH ST
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548-2910
Practice Address - Country:US
Practice Address - Phone:337-643-8300
Practice Address - Fax:337-643-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA149273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1705616Medicaid
LA61217OtherBCBS -PYSCH
LA61217OtherBCBS -PYSCH