Healthcare Provider Details

I. General information

NPI: 1598766495
Provider Name (Legal Business Name): OUR LADY OF LOURDES REGIONAL MEDICAL CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6917
US

IV. Provider business mailing address

4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6917
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-2000
  • Fax: 337-289-2170
Mailing address:
  • Phone: 337-470-2000
  • Fax: 337-289-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. WILLIAM BRYAN LEE
Title or Position: CEO
Credential:
Phone: 337-470-2000