Healthcare Provider Details

I. General information

NPI: 1679935928
Provider Name (Legal Business Name): STERLINGTON CRITICAL ACCESS HOSPITAL L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 W HICKORY AVE
BASTROP LA
71220-4442
US

IV. Provider business mailing address

PO BOX 627
STERLINGTON LA
71280-0627
US

V. Phone/Fax

Practice location:
  • Phone: 318-281-4531
  • Fax: 318-281-4534
Mailing address:
  • Phone: 318-665-9950
  • Fax: 318-665-9906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2203781103
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2203781103
License Number StateLA

VIII. Authorized Official

Name: MRS. LAURIE DOSS
Title or Position: BILLING
Credential:
Phone: 318-665-9950