Provider Demographics
NPI:1952565335
Name:CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE
Entity Type:Organization
Organization Name:CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE
Other - Org Name:TRINITY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NEKEISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-757-6551
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-0111
Mailing Address - Country:US
Mailing Address - Phone:318-757-6551
Mailing Address - Fax:318-757-6832
Practice Address - Street 1:6569 HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-4573
Practice Address - Country:US
Practice Address - Phone:318-757-6551
Practice Address - Fax:318-757-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QC0050X, 261QM1300X
LA247282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1752231Medicaid