NPIMap

Organization Active NPI

Catahoula Parish Hospital District No 2

  • Federally Qualified Health Center (FQHC)
  • Wisner, LA
National Provider Identifier
1386784569
Registry record updated May 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CATAHOULA PARISH HOSPITAL DISTRICT NO 2
Practice address
126 Watson Street
Wisner, LA 71378-0269
Phone
(318) 724-7008
Fax
(318) 724-7646
NPI assigned
Feb 7, 2007
Last updated
May 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Debra K Miesch, MBA
Title
Ceo
Phone
(318) 389-5727

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X LA Primary

Addresses

Primary practice location

126 Watson Street
Wisner, LA 71378-0269

Mailing address

PO Box 269
126 Watson Street
Wisner, LA 71378-0269
Phone (318) 724-7008

Other identifiers 3

IdentifierTypeStateIssuer
1903191MedicaidLA
1946036MedicaidLA
10464OtherLABLUE CROSS LA

Other names 1

  • Catahoula Parish Hospital Dist. #2 Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040716000202 LA Part B Supplier - Clinic/Group Practice 8729067434 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ferriday, LA; Wisner, LA; Sicily Island, LA; Harrisonburg, LA; Jonesville, LA
O20101011000165 LA Part A Provider - Federally Qualified Health Center (FQHC) 8729067434 Practice locations: Wisner, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386784569. Details of each certification follow.

Federally qualified health center certification: CCN 191824

Legal name
CATAHOULA PARISH HOSPITAL DISTRICT NO 2
Doing business as
WISNER MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 31, 1995
Last certification
Jul 31, 1995
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
126 Watson Rd
Wisner, LA 71378-4660

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Catahoula Parish Hospit7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kathryn Crews Individual Corporate Director Jul 13, 2010
Sharon Gilmore Individual Corporate Director Jul 13, 2010
Clara Valentine Individual Corporate Director Jul 12, 2010
Renee Ford Individual W-2 Managing Employee Jul 13, 2010
Debra Miesch Individual 5% Or Greater Direct Ownership InterestAuthorized Official Jan 1, 2015 20%
Michelle P Brown Individual Corporate Officer Jan 1, 2014 5%
Marc McCarty Individual Corporate Director Jul 13, 2010
Trellis Brass Individual Corporate Director Jul 13, 2010
Jackie Myers Individual Corporate Director Jul 13, 2010

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ferriday Family Health CenterFerriday, LA, CCN 191846 Federally qualified health center Operational/Managerial Control Jul 12, 2010
Jonesville Medical CenterJonesville, LA, CCN 191947 Federally qualified health center 5% Or Greater Direct Ownership Interest (25%) Jan 1, 2015

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652054400000",
    "number": "1386784569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 269",
            "address_2": "126 WATSON STREET",
            "city": "WISNER",
            "state": "LA",
            "postal_code": "713780269",
            "telephone_number": "318-724-7008",
            "fax_number": "318-724-7646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 WATSON STREET",
            "city": "WISNER",
            "state": "LA",
            "postal_code": "713780269",
            "telephone_number": "318-724-7008",
            "fax_number": "318-724-7646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CATAHOULA PARISH HOSPITAL DISTRICT NO 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A",
        "authorized_official_last_name": "MIESCH",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-389-5727",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1903191",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1946036",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS LA",
            "identifier": "10464",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Catahoula Parish Hospital Dist. #2",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Wisner, LA

Sources for this page

Verify at the official NPI Registry.