Healthcare Provider Details

I. General information

NPI: 1053415745
Provider Name (Legal Business Name): LASALLE PARISH HOSPITAL SERVICE DISTRICT #1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 NORTH PINE ROAD
OLLA LA
71465
US

IV. Provider business mailing address

1049 N PINE RD
OLLA LA
71465-4826
US

V. Phone/Fax

Practice location:
  • Phone: 318-495-3880
  • Fax: 318-495-3882
Mailing address:
  • Phone: 318-495-3880
  • Fax: 318-495-0773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number178RHC-1
License Number StateLA

VIII. Authorized Official

Name: MR. PAUL G MATHEWS
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-495-3131