Provider Demographics
NPI:1326016684
Name:NORTH CADDO HOSPITAL SERVICE DISTRICT
Entity type:Organization
Organization Name:NORTH CADDO HOSPITAL SERVICE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/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:
Authorized Official - Phone:318-375-3235
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-0792
Mailing Address - Country:US
Mailing Address - Phone:318-375-3235
Mailing Address - Fax:318-375-5938
Practice Address - Street 1:815 S PINE ST
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3314
Practice Address - Country:US
Practice Address - Phone:318-375-3235
Practice Address - Fax:318-375-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119810303Medicaid
LA22037783599OtherSTATE LICENSE
LA1753190Medicaid
LA193476Medicare Oscar/Certification
LA5D072Medicare PIN