Basic Information
| Provider Information | |||||||||
| NPI: | 1518924109 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TERREBONNE PARISH HOSPITAL SERVICE DISTRICT #1 | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | TERREBONNE GENERAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6037 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703616037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858734235 | ||||||||
| FaxNumber: | 9858514307 | ||||||||
| Practice Location | |||||||||
| Address1: | 8166 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858734141 | ||||||||
| FaxNumber: | 9858514307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 04/23/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | YEATES | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9858734664 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CPA MBA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 159 | LA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 13064 | 01 | LA | BLUE CROSS | OTHER | 1720275 | 05 | LA | MEDICAID | 474543 | 01 | AETNA | OTHER | 1795887 | 05 | LA | MEDICAID | 5000076 | 01 | LA | UNITED HEALTHCARE | OTHER | 5D037 | 01 | MEDICARE PROFESSIONAL | OTHER | 90008 | 01 | LA | BLUE CROSS | OTHER |