Provider Demographics
NPI:1285835561
Name:BIENVILLE MEDICAL CENTER INC
Entity type:Organization
Organization Name:BIENVILLE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDELON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-226-8202
Mailing Address - Street 1:3800 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-7403
Mailing Address - Country:US
Mailing Address - Phone:318-629-5321
Mailing Address - Fax:318-226-8205
Practice Address - Street 1:1175 PINE ST STE 200
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-3113
Practice Address - Country:US
Practice Address - Phone:318-629-5321
Practice Address - Fax:318-226-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA552275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1707023Medicaid
LA19Z320Medicare Oscar/Certification
LA1707023Medicaid