Basic Information
| Provider Information | |||||||||
| NPI: | 1316133671 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EUREKA SPINGS HOSPITAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 504 TEXAS ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711013526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182268202 | ||||||||
| FaxNumber: | 3182268205 | ||||||||
| Practice Location | |||||||||
| Address1: | 504 TEXAS ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711013526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182268202 | ||||||||
| FaxNumber: | 3182268205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 09/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | BORDELON | ||||||||
| AuthorizedOfficialFirstName: | ROCK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3182268202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.