1831193499 NPI number — HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA

Table of content: (NPI 1831193499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831193499 NPI number — HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA
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:
BEAUREGARD MEMORIAL HOSPITAL
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:
1831193499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 S PINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERIDDER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70634-4942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-462-7100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 S PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERIDDER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70634-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-462-7100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KINGHAM
Authorized Official First Name:
DARRELL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
337-462-7100

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  155 , 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)

  • Identifier: 1720038 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60794 . This is a "BLUE CROSS PROVIDER NO." identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 720491106001 . This is a "CHAMPUS UB92 PROVIDER NO." identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 720491106007 . This is a "CHAMPUS 1500 PROVIDER NO." identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 720491106002 . This is a "CHAMPUS SNF PROVIDER NO." identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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