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Concordia Parish Hospital Service District Number One

Organization Active NPI Rural Health Clinic/Center · Vidalia, LA

NPI 1780190322 · NPPES record last updated Oct 5, 2022

Key facts

NPI
1780190322
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE
Practice address
1643 Carter St
Vidalia, LA 71373-3156
Phone
(318) 336-8707
NPI assigned
Dec 19, 2017
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 4

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

Owned or controlled facilities with NPI records 3

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

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same tax ID) 4

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

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

Facilities with the same owner 3

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

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 33

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2080217Trinity Medical Vidalia Clinic
1643 Carter Street, Suite 1, Vidalia, LA 71373		Certificate of waiverJul 1, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

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
Other · Non-profit
Enrollment address
1643 Carter St, Ste 1
Vidalia, LA 71373-3157
Related CCNs
191318

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 Employee
Ceo		 Feb 1, 2021

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

Medicare enrollment records

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

National Provider Directory

Tax ID family
Concordia Parish HSD No 1 (5 organizations share this tax ID)

Locations

6569 Highway 84
Ridgecrest, LA 71334
Phone 3187576551605

1643 Carter St
Ste 1
Vidalia, LA 71373
Phone (318) 336-4444

1634 Carter St
Ste 1
Vidalia, LA 71373

1643 Carter St
Vidalia, LA 71373
Phone (318) 336-8707

1495 US Highway 61 S
Ste A
Woodville, MS 39669
Phone (601) 446-5315

Specialties & licenses

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

Addresses

Primary practice location

1643 Carter St
Vidalia, LA 71373-3156

Mailing address

PO Box 111
Ferriday, LA 71334-0111

Other identifiers

IdentifierTypeStateIssuer
2481011MedicaidLA

Other names

  • TRINITY MEDICAL VIDALIA CLINIC Doing business as

Other providers in Vidalia, LA

All providers in Vidalia, LA · Rural Health Clinic/Center in Louisiana

Sources for this page

Verify at the official NPI Registry.