Basic Information
| Provider Information | |||||||||
| NPI: | 1124092481 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRINGHILL MEDICAL SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SPRINGHILL MEDICAL CENTER HOSPITAL BASED PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 DOCTORS DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGHILL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710754526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185391000 | ||||||||
| FaxNumber: | 3185394085 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 DOCTORS DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGHILL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710754526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185391000 | ||||||||
| FaxNumber: | 3185394085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PATRONIS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3185391001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SPRINGHILL MEDICAL SERVICES, INC. | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 2085R0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207Q00000X | 441 | LA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1441601 | 05 | LA | MEDICAID |