Provider Demographics
NPI:1902987548
Name:MADISON PARISH SERVICE DISTRICT HOSPITAL
Entity Type:Organization
Organization Name:MADISON PARISH SERVICE DISTRICT HOSPITAL
Other - Org Name:MADISON PARISH HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-574-2374
Mailing Address - Street 1:10 CROTHERS DR
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-5510
Mailing Address - Country:US
Mailing Address - Phone:318-574-2764
Mailing Address - Fax:318-574-3398
Practice Address - Street 1:10 CROTHERS DR
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-5510
Practice Address - Country:US
Practice Address - Phone:318-574-2764
Practice Address - Fax:318-574-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty