Provider Demographics
NPI:1104413384
Name:NORTHEAST LOUISIANA PHYSICIAN HOSPITAL ORGANIZATION
Entity type:Organization
Organization Name:NORTHEAST LOUISIANA PHYSICIAN HOSPITAL ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-387-7358
Mailing Address - Street 1:1900 N 18TH ST STE 703
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4486
Mailing Address - Country:US
Mailing Address - Phone:318-372-5431
Mailing Address - Fax:318-387-7358
Practice Address - Street 1:1900 N 18TH ST STE 703
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4486
Practice Address - Country:US
Practice Address - Phone:318-372-5431
Practice Address - Fax:318-387-7358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization