Healthcare Provider Details

I. General information

NPI: 1477886141
Provider Name (Legal Business Name): ST MARTIN HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CHAMPAGNE BOULEVARD
BREAUX BRIDGE LA
70517-3700
US

IV. Provider business mailing address

210 CHAMPAGNE BOULEVARD
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 Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID L CALLECOD
Title or Position: AUTHORIZED DELEGATE
Credential:
Phone: 337-289-7374