Provider Demographics
NPI:1124155411
Name:NORTH CADDO MEDICAL CENTER HEALTHPLEX
Entity type:Organization
Organization Name:NORTH CADDO MEDICAL CENTER HEALTHPLEX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:318-375-3235
Mailing Address - Street 1:102 INDUSTRIAL DRIVE
Mailing Address - Street 2:P.O. BOX 952
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082
Mailing Address - Country:US
Mailing Address - Phone:318-375-2808
Mailing Address - Fax:318-375-5032
Practice Address - Street 1:102 INDUSTRIAL DRIVE
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082
Practice Address - Country:US
Practice Address - Phone:318-375-2808
Practice Address - Fax:318-375-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA210A251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1410501Medicare UPIN