| Desoto Hospital Assocation | |
|
808 Main Street Logansport LA 71049 | |
| (318) 697-2273 | |
| (318) 697-2277 |
| Full Name | Desoto Hospital Assocation |
|---|---|
| Speciality | Clinic/Center |
| Location | 808 Main Street, Logansport, Louisiana |
| Authorized Official Name and Position | Hallie Deutsch (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3188713101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desoto Hospital Assocation 808 Main Street Logansport LA 71049 Ph: (318) 697-2273 | Desoto Hospital Assocation 808 Main Street Logansport LA 71049 Ph: (318) 697-2273 |
| NPI Number | 1457489593 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 10/08/2025 |
| Medicare PECOS PAC ID | 8022188176 |
|---|---|
| Medicare Enrollment ID | O20080602000779 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457489593 | NPI | - | NPPES |
| 1445932 | Medicaid | LA | |
| 5C630 | Other | LA | MDEICARE |
| 193448 | Other | LA | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (Louisiana) | Primary |
| Provider Name | Melissa Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790750362 PECOS PAC ID: 3274603329 Enrollment ID: I20080602000798 |
| Provider Name | Tiffany George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760738801 PECOS PAC ID: 9739335647 Enrollment ID: I20120808000931 |
| Provider Name | Angela Christine Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942650429 PECOS PAC ID: 7517250020 Enrollment ID: I20170425000658 |
Desoto Hospital Assocation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 808 Main St, Logansport, LA 71049 Phone: 318-697-2273 |