1700129749 NPI number — ABBEVILLE GENERAL HOSPITAL

Table of content: (NPI 1700129749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700129749 NPI number — ABBEVILLE GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABBEVILLE GENERAL HOSPITAL
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:
ERATH/DELCAMBRE COMMUITY CARE CLINIC
Provider Other Organization Name Type Code:
5
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:
1700129749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 N HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABBEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70510-4039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-893-5466
Provider Business Mailing Address Fax Number:
337-893-2801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 NORTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERATH
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70533-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-937-5944
Provider Business Practice Location Address Fax Number:
337-898-6506
Provider Enumeration Date:
03/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LANDRY
Authorized Official First Name:
RAY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
337-893-5466

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2360051 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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