Provider Demographics
NPI:1386049518
Name:HOSPITAL SERVICE DISTRICT NO. 1 OF TANGIPAHOA PARISH
Entity type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT NO. 1 OF TANGIPAHOA PARISH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.F.O
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-230-6602
Mailing Address - Street 1:15790 PAUL VEGA MD DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1434
Mailing Address - Country:US
Mailing Address - Phone:985-230-7979
Mailing Address - Fax:985-230-6484
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:RETAIL PHARMACY
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-3383
Practice Address - Fax:985-230-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA69793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2203151Medicaid
LA6979OtherPHARMACY PERMIT NUMBER