Provider Demographics
NPI:1285779363
Name:ABBEVILLE GENERAL HOSPITAL
Entity type:Organization
Organization Name:ABBEVILLE GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-893-5466
Mailing Address - Street 1:118 N HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4039
Mailing Address - Country:US
Mailing Address - Phone:337-898-6525
Mailing Address - Fax:337-898-6506
Practice Address - Street 1:118 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4039
Practice Address - Country:US
Practice Address - Phone:337-898-6516
Practice Address - Fax:337-898-9695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABBEVILLE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CT52OtherMEDICARE PTAN #
LA1753742Medicaid