1063630382 NPI number — RUSTON LOUISIANA HOSPITAL COMPANY LLC

Table of content: (NPI 1063630382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063630382 NPI number — RUSTON LOUISIANA HOSPITAL COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSTON LOUISIANA HOSPITAL COMPANY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CANCER INSTITUTE OF NORTHERN LOUISIANA MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063630382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 COMMERCE WAY
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-2829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-892-9813
Provider Business Mailing Address Fax Number:
615-465-3007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 E VAUGHN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71270-5950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-254-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BREWER
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
877-892-9813

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , with the licence number:  08523R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)