Healthcare Provider Details

I. General information

NPI: 1619469202
Provider Name (Legal Business Name): ST MARTIN HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 GARY DR STE A
BREAUX BRIDGE LA
70517-3448
US

IV. Provider business mailing address

920 W PINHOOK RD
LAFAYETTE LA
70503-2455
US

V. Phone/Fax

Practice location:
  • Phone: 337-909-2474
  • Fax:
Mailing address:
  • Phone: 337-289-8684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number672
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number672
License Number StateLA

VIII. Authorized Official

Name: SANDRA KELLER
Title or Position: VP COMPLIANCE
Credential:
Phone: 337-289-8684