1154779874 NPI number — JENNINGS AMERICAN LEGION HOSPITAL INC

Table of content: (NPI 1154779874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154779874 NPI number — JENNINGS AMERICAN LEGION HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNINGS AMERICAN LEGION HOSPITAL INC
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:
LAKE ARTHUR CLINIC OF JALH
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:
1154779874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1634 ELTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JENNINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70546-3614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-616-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
328 KELLOGG AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ARTHUR
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-774-0100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
DANA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
337-616-7000

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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