Healthcare Provider Details

I. General information

NPI: 1073641866
Provider Name (Legal Business Name): WASHINGTON ST. TAMMANY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 NORTH AVE
BOGALUSA LA
70427-4428
US

IV. Provider business mailing address

433 PLAZA ST
BOGALUSA LA
70427-3729
US

V. Phone/Fax

Practice location:
  • Phone: 985-732-7122
  • Fax:
Mailing address:
  • Phone: 985-732-7122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD R SMITHBURG
Title or Position: VICE CHANCELLOR CEO
Credential:
Phone: 225-922-1474