Healthcare Provider Details

I. General information

NPI: 1952836629
Provider Name (Legal Business Name): HOSPITAL SERVICE DISTRICT NO 1 OF THE PARRISH OF JEFFERSON DAVIS LA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 ELTON RD
JENNINGS LA
70546-3614
US

IV. Provider business mailing address

1634 ELTON RD
JENNINGS LA
70546-3614
US

V. Phone/Fax

Practice location:
  • Phone: 337-616-7030
  • Fax: 337-616-7034
Mailing address:
  • Phone: 337-616-7030
  • Fax: 337-616-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES W RICHERT JR.
Title or Position: BOARD MEMBER
Credential:
Phone: 337-824-5094