NPIMap

Organization Active NPI

Concordia Parish Hospital Service District Number One

Doing business as Trinity Medical Vidalia Clinic

  • Rural Health Clinic/Center
  • Vidalia, LA
National Provider Identifier
1780190322
Registry record updated Oct 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE
Doing business as
Trinity Medical Vidalia Clinic
Practice address
1643 Carter St
Vidalia, LA 71373-3156
Phone
(318) 336-8707
NPI assigned
Dec 19, 2017
Last updated
Oct 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2022

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

Authorized official

Name
Nekeisha Lashay Smith
Title
Administrator
Phone
(318) 719-3636

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X LA Primary

Addresses

Primary practice location

1643 Carter St
Vidalia, LA 71373-3156

Mailing address

PO Box 111
Ferriday, LA 71334-0111

Other names 1

  • TRINITY MEDICAL VIDALIA CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171213002360 LA Part A Provider - Rural Health Clinic 4587559935 Practice locations: Vidalia, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780190322. Details of each certification follow.

Rural health clinic certification: CCN 198502

Legal name
CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE
Doing business as
TRINITY MEDICAL VIDALIA CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 6, 2018
Last certification
Mar 6, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1643 Carter St, Ste 1
Vidalia, LA 71373-3157
Related CCNs
191318

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2080217Trinity Medical Vidalia Clinic1643 Carter Street, Suite 1, Vidalia, LA 71373Certificate of waiverJul 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Newellton Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Concordia Parish Hospital Service District Number One Organization, Ferriday, LA Non-profit 5% Or Greater Direct Ownership Interest Jan 12, 2021 100%
Operational/Managerial Control Jan 12, 2021 100%
Connie Vigil Individual Corporate Director Aug 12, 2019
Nekeisha Smith Individual W-2 Managing EmployeeCeo Feb 1, 2021

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Trinity MedicalFerriday, LA, CCN 191318 Hospital Operational/Managerial Control Jun 1, 1966
Trinity MedicalFerriday, LA, CCN 19Z318 Hospital 5% Or Greater Indirect Ownership Interest
Operational/Managerial Control		 Nov 1, 2004
Nov 1, 2004
Trinity Medical Ferriday ClinicFerriday, LA, CCN 198514 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2015
May 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.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 5

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": "1513641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664928000000",
    "number": "1780190322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 111",
            "city": "FERRIDAY",
            "state": "LA",
            "postal_code": "713340111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1643 CARTER ST",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713733156",
            "telephone_number": "318-336-8707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-19",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "NEKEISHA",
        "authorized_official_middle_name": "LASHAY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-719-3636"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRINITY MEDICAL VIDALIA CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vidalia, LA

Sources for this page

Verify at the official NPI Registry.