1093129124 NPI number — BAYNE-JONES ARMY COMMUNITY HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093129124 NPI number — BAYNE-JONES ARMY COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYNE-JONES ARMY COMMUNITY 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:
Provider Other Organization Name Type Code:
6
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:
1093129124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1585 3RD ST
Provider Second Line Business Mailing Address:
BLDG 285
Provider Business Mailing Address City Name:
FORT POLK
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71459-5102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-531-3482
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2040 DRAGOON LOOP
Provider Second Line Business Practice Location Address:
BLDG 1170
Provider Business Practice Location Address City Name:
FORT POLK
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71459-5242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-531-3118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
UBO
Authorized Official Telephone Number:
337-653-3220

Provider Taxonomy Codes

  • Taxonomy code: 261QM1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1104991215 . This is a "PARENT BJACH NPI 2" identifier . This identifiers is of the category "OTHER".




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