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General NPI Number Information
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NPI Number | 1407175615
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Entity Type | Organization
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Legal Business Name | ST. MARTIN HOSPITAL, INC.
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 210 CHAMPAGNE BLVD
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City | BREAUX BRIDGE
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State | LA
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Zip | 70517-3700
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Country | US
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Telephone | 337-332-2178
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Fax | 337-332-5092
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Provider Business Mailing Address
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Address Line | 210 CHAMPAGNE BLVD
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City | BREAUX BRIDGE
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State | LA
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Zip | 70517-3700
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Country | US
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Telephone | 337-332-2178
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Fax | 337-332-5092
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Authorized Official
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Title or Position | AVP
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Name | MRS. JENNIFER VICKNAIR
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Credential |
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Telephone | 337-332-2178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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