Basic Information
| Provider Information | |||||||||
| NPI: | 1861531014 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CATAHOULA PARISH HOSPITAL DISTRICT NO 2 | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CATAHOULA PARISH HOSPITAL DIST #2 | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 SERIO BLVD | ||||||||
| Address2: | |||||||||
| City: | FERRIDAY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713342253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187576969 | ||||||||
| FaxNumber: | 3187576966 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SERIO BLVD | ||||||||
| Address2: | |||||||||
| City: | FERRIDAY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713342253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187576969 | ||||||||
| FaxNumber: | 3187576966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MIESCH | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3183895727 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | LA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 1448371 | 05 | LA | MEDICAID | 1903191 | 05 | LA | MEDICAID | 10464 | 01 | LA | BLUE CROSS LA | OTHER |