Basic Information
| Provider Information | |||||||||
| NPI: | 1699191999 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRINGHILL MEDICAL SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MUDDY BOTTOMS CLINIC | ||||||||
| 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: | 369 MUDDY BOTTOMS DRIVE | ||||||||
| Address2: | |||||||||
| City: | SAREPTA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185391000 | ||||||||
| FaxNumber: | 3185394085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2014 | ||||||||
| LastUpdateDate: | 06/06/2014 | ||||||||
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| AuthorizedOfficialLastName: | SEDMINK | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3185391001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 441 | LA | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.