Healthcare Provider Details

I. General information

NPI: 1528586518
Provider Name (Legal Business Name): HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 MCHUGH RD STE A
ZACHARY LA
70791-5364
US

IV. Provider business mailing address

2335 CHURCH ST STE E
ZACHARY LA
70791-2700
US

V. Phone/Fax

Practice location:
  • Phone: 225-658-6640
  • Fax: 225-658-6653
Mailing address:
  • Phone: 225-654-3607
  • Fax: 225-658-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: LARRY R MEESE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 225-658-4303