Healthcare Provider Details

I. General information

NPI: 1417124959
Provider Name (Legal Business Name): NORTH CADDO HOSPITAL SERVICE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S PINE ST
VIVIAN LA
71082-3314
US

IV. Provider business mailing address

PO BOX 792
VIVIAN LA
71082-0792
US

V. Phone/Fax

Practice location:
  • Phone: 318-375-3235
  • Fax: 318-375-5938
Mailing address:
  • Phone: 318-375-3235
  • Fax: 318-375-5938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number210
License Number StateLA

VIII. Authorized Official

Name: MR. DAVID JONES
Title or Position: CEO
Credential:
Phone: 318-375-4001