Provider Demographics
NPI:1063882793
Name:CSS OF HAMMOND LLC
Entity type:Organization
Organization Name:CSS OF HAMMOND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-323-3382
Mailing Address - Street 1:19184 DR JOHN LAMBERT DR
Mailing Address - Street 2:STE. 104
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0936
Mailing Address - Country:US
Mailing Address - Phone:985-542-7150
Mailing Address - Fax:985-542-7155
Practice Address - Street 1:19184 DR JOHN LAMBERT DR
Practice Address - Street 2:STE. 104
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0936
Practice Address - Country:US
Practice Address - Phone:985-542-7150
Practice Address - Fax:985-542-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA503799OtherMCARE PTAN