1801801436 NPI number — WASHINGTON ST. TAMMANY REGIONAL MEDICAL CENTER

Table of content: (NPI 1801801436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801801436 NPI number — WASHINGTON ST. TAMMANY REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON ST. TAMMANY REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OUTPATIENT PROCUREMENT PHARMACY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801801436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 PLAZA STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOGALUSA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-730-2208
Provider Business Mailing Address Fax Number:
985-730-2209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 MEMPHIS STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOGALUSA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-730-2208
Provider Business Practice Location Address Fax Number:
985-730-2209
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUMMINGS
Authorized Official First Name:
BROOKE
Authorized Official Middle Name:
WASCOM
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
985-730-2208

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  5550IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 5550-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1932816 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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