Healthcare Provider Details

I. General information

NPI: 1558520957
Provider Name (Legal Business Name): DEQUINCY MEMORIAL HOSPITAL,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W 4TH ST
DEQUINCY LA
70633-3508
US

IV. Provider business mailing address

110 W 4TH ST PO BOX 1166
DEQUINCY LA
70633-3508
US

V. Phone/Fax

Practice location:
  • Phone: 337-786-1200
  • Fax: 337-786-1219
Mailing address:
  • Phone: 337-786-1200
  • Fax: 337-786-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number429
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number429
License Number StateLA

VIII. Authorized Official

Name: MRS. BRENDA B COOLEY
Title or Position: INSURANCE MANAGER
Credential:
Phone: 337-786-1200