Basic Information
| Provider Information | |||||||||
| NPI: | 1114222072 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CALDWELL MEMORIAL HOSPITAL, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | CHATHAM RURAL HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 899 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714180899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186496111 | ||||||||
| FaxNumber: | 3186495094 | ||||||||
| Practice Location | |||||||||
| Address1: | 6619 HIGHWAY 34 | ||||||||
| Address2: | |||||||||
| City: | CHATHAM | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712269326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182492743 | ||||||||
| FaxNumber: | 3186495094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2011 | ||||||||
| LastUpdateDate: | 03/06/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ETHERIDGE | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3182492743 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CALDWELL MEMORIAL HOSPITAL, INC | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.