Basic Information
| Provider Information | |||||||||
| NPI: | 1588158497 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CALDWELL MEMORIAL HOSPITAL INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CALDWELL HOSPITAL CLINIC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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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: | 411 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714186704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186496111 | ||||||||
| FaxNumber: | 3186495094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ETHERIDGE | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3186496111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 113 | LA | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 1798827 | 05 | LA | MEDICAID |