Healthcare Provider Details

I. General information

NPI: 1104413384
Provider Name (Legal Business Name): NORTHEAST LOUISIANA PHYSICIAN HOSPITAL ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N 18TH ST STE 703
MONROE LA
71201-4486
US

IV. Provider business mailing address

1900 N 18TH ST STE 703
MONROE LA
71201-4486
US

V. Phone/Fax

Practice location:
  • Phone: 318-372-5431
  • Fax: 318-387-7358
Mailing address:
  • Phone: 318-372-5431
  • Fax: 318-387-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONICA LYNN PITTMAN
Title or Position: PRESIDENT
Credential:
Phone: 318-387-7358