Healthcare Provider Details

I. General information

NPI: 1912052945
Provider Name (Legal Business Name): IASIS GLENWOOD REGIONAL MEDICAL CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 RIDGEDALE DR
WEST MONROE LA
71291-2017
US

IV. Provider business mailing address

503 MCMILLAN ROAD ATTN: BILLING
WEST MONROE LA
71291-5327
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-4525
  • Fax: 318-329-4526
Mailing address:
  • Phone: 318-329-4200
  • Fax: 318-329-4710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: JEREMY M TINNERELLO
Title or Position: HOSPITAL CEO
Credential:
Phone: 318-329-4200