Healthcare Provider Details

I. General information

NPI: 1801801436
Provider Name (Legal Business Name): WASHINGTON ST. TAMMANY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MEMPHIS STREET
BOGALUSA LA
70427
US

IV. Provider business mailing address

433 PLAZA STREET
BOGALUSA LA
70427
US

V. Phone/Fax

Practice location:
  • Phone: 985-730-2208
  • Fax: 985-730-2209
Mailing address:
  • Phone: 985-730-2208
  • Fax: 985-730-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5550IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5550-IR
License Number StateLA

VIII. Authorized Official

Name: MRS. BROOKE WASCOM CUMMINGS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 985-730-2208