Healthcare Provider Details

I. General information

NPI: 1518106962
Provider Name (Legal Business Name): HUEY P. LONG REG MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 HOSPITAL BLVD
PINEVILLE LA
71361-5352
US

IV. Provider business mailing address

352 HOSPITAL ROAD
PINEVILLE LA
71360-0000
US

V. Phone/Fax

Practice location:
  • Phone: 318-448-0811
  • Fax: 318-473-6360
Mailing address:
  • Phone: 318-448-0811
  • Fax: 318-473-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number255
License Number StateLA

VIII. Authorized Official

Name: MRS. MELANIE H SOTAK
Title or Position: DIRECTOR OF MANAGED CARE
Credential: MHSA
Phone: 318-675-7737