Provider Demographics
NPI:1285083154
Name:LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1
Entity type:Organization
Organization Name:LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINIC OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAFONT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:985-325-9300
Mailing Address - Street 1:200 W 134TH PL
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-4143
Mailing Address - Country:US
Mailing Address - Phone:985-325-9300
Mailing Address - Fax:985-632-1029
Practice Address - Street 1:180-B A.O. RAPPELET ROAD
Practice Address - Street 2:
Practice Address - City:GOLDEN MEADOW
Practice Address - State:LA
Practice Address - Zip Code:70357
Practice Address - Country:US
Practice Address - Phone:985-396-5250
Practice Address - Fax:985-396-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2436490Medicaid
LA5CH34Medicare PIN