=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295473809
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMMOND SURGICAL HOSPITAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2022
-----------------------------------------------------
Last Update Date | 05/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19184 DR JOHN LAMBERT DR STE A
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70403-0935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-542-7766
-----------------------------------------------------
Fax | 985-542-1754
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42570 S AIRPORT RD
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70403-0946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-510-6200
-----------------------------------------------------
Fax | 985-510-6202
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF NURSING OFFICER
-----------------------------------------------------
Name | JULIE DIODENE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 985-510-6200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2088P0231X
-----------------------------------------------------
Taxonomy Name | Pediatric Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------