Healthcare Provider Details

I. General information

NPI: 1407175615
Provider Name (Legal Business Name): ST. MARTIN HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CHAMPAGNE BLVD
BREAUX BRIDGE LA
70517-3700
US

IV. Provider business mailing address

210 CHAMPAGNE BLVD
BREAUX BRIDGE LA
70517-3700
US

V. Phone/Fax

Practice location:
  • Phone: 337-332-2178
  • Fax: 337-332-5092
Mailing address:
  • Phone: 337-332-2178
  • Fax: 337-332-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER VICKNAIR
Title or Position: AVP
Credential:
Phone: 337-332-2178