Healthcare Provider Details

I. General information

NPI: 1013181866
Provider Name (Legal Business Name): NORTH CADDO HOSPITAL SERVICE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
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: 318-375-3239
  • Fax: 318-375-2755
Mailing address:
  • Phone: 318-375-3239
  • Fax: 318-375-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAKOTA ROBINSON
Title or Position: CFO
Credential:
Phone: 318-375-4097