Healthcare Provider Details

I. General information

NPI: 1891126728
Provider Name (Legal Business Name): STONEBRIDGE HEALTH SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 W CREOLE HWY STE 2
CAMERON LA
70631-5127
US

IV. Provider business mailing address

5360 WEST CREOLE HWY
CAMERON LA
70631-8785
US

V. Phone/Fax

Practice location:
  • Phone: 337-564-6770
  • Fax: 337-564-6771
Mailing address:
  • Phone: 337-542-4111
  • Fax: 337-542-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2203782007
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2203782007
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLIE TRAHAN
Title or Position: MANAGER/MEMBER
Credential:
Phone: 337-542-4111