MEDICARE: LASALLE PARISH HOSPITAL SERVICE DISTRICT #1

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NC0060X	Critical Access Hospital	178	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5D105	OTHER	LA	PINNACLE MEDICARE

General Provider Information

NPI Number	:	1184815466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LASALLE PARISH HOSPITAL SERVICE DISTRICT #1

Provider Business Mailing Address
First Line	:	1102 N PINE RD
Second Line	:
City	:	OLLA
State	:	LA
Zip	:	71465-4804
Country	:	US
Telephone Number	:	318-495-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 N PINE RD
Second Line	:
City	:	OLLA
State	:	LA
Zip	:	71465-4804
Country	:	US
Telephone Number	:	318-495-3131
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. PAUL G MATHEWS
Credential	:
Telephone Number	:	318-495-3131

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	04/21/2023

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Practice Location Address:

1102 NORTH PINE STREET
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Directions to “LASALLE PARISH HOSPITAL SERVICE DISTRICT #1 ” Practice Location

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