Healthcare Provider Details

I. General information

NPI: 1467455154
Provider Name (Legal Business Name): DESOTO HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 JEFFERSON ST
MANSFIELD LA
71052-2603
US

IV. Provider business mailing address

207 JEFFERSON ST
MANSFIELD LA
71052-2603
US

V. Phone/Fax

Practice location:
  • Phone: 318-872-4610
  • Fax: 318-872-1502
Mailing address:
  • Phone: 318-872-4610
  • Fax: 318-872-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number229
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TODD EPPLER
Title or Position: CEO
Credential:
Phone: 318-872-4610