NPIMap

Organization Active NPI

East Carroll Parish Hospital

Doing business as East Carroll Medical Clinic

  • Rural Health Clinic/Center
  • Lake Providence, LA
National Provider Identifier
1902885650
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EAST CARROLL PARISH HOSPITAL
Doing business as
East Carroll Medical Clinic
Practice address
340 N Hood St
Lake Providence, LA 71254-2140
Phone
(318) 559-2404
Fax
(318) 559-1772
NPI assigned
Jan 11, 2006
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Lindsay Layton, LPN
Title
Clinic & Central Billing Director
Phone
(318) 559-3303

Specialties & licenses 1

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

Addresses

Primary practice location

340 N Hood St
Lake Providence, LA 71254-2140

Mailing address

340 N Hood St
Lake Providence, LA 71254-2140
Phone (318) 559-2404

Other identifiers 1

IdentifierTypeStateIssuer
1947873MedicaidLA

Other names 1

  • East Carroll Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040216000563 LA Part B Supplier - Clinic/Group Practice 1153216619 Receives reassigned benefits from 78 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lake Providence, LA
O20100506000580 AR Part A Provider - Rural Health Clinic 1153216619 Practice locations: Lake Providence, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902885650. Details of each certification follow.

Rural health clinic certification: CCN 193431

Legal name
EAST CARROLL PARISH HOSPITAL
Doing business as
EAST CARROLL MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 18, 1997
Last certification
Jan 19, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Sep 8, 1997 in LA
Enrollment address
340 N Hood St
Lake Providence, LA 71254
Related CCNs
190208

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

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
19D0927607East Carroll Medical Clinic340 N Hood Street, Lake Providence, LA 71254Certificate of waiverAug 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
East Carroll Ambulance Service4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

336 N Hood St
Lk Providence, LA 71254
Phone (318) 559-4023

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Ladonna Englerth Individual Corporate DirectorCeo Oct 9, 1986 100%
W-2 Managing EmployeeCeo Oct 9, 1986 100%

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1902885650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 N HOOD ST",
            "city": "LAKE PROVIDENCE",
            "state": "LA",
            "postal_code": "712542140",
            "telephone_number": "318-559-2404",
            "fax_number": "318-559-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 N HOOD ST",
            "city": "LAKE PROVIDENCE",
            "state": "LA",
            "postal_code": "712542140",
            "telephone_number": "318-559-2404",
            "fax_number": "318-559-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CARROLL PARISH HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-11",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "LAYTON",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_title_or_position": "CLINIC & CENTRAL BILLING DIRECTOR",
        "authorized_official_telephone_number": "318-559-3303",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1947873",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Carroll Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Providence, LA

Sources for this page

Verify at the official NPI Registry.