Healthcare Provider Details

I. General information

NPI: 1679730667
Provider Name (Legal Business Name): DESOTO HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 11/20/2020
Certification Date: 11/09/2020
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 TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number229
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTOPHER DAVIS
Title or Position: VP OF FINIANCE
Credential:
Phone: 318-872-2700