Provider Demographics
NPI:1932246261
Name:HOSPITAL SERVICE DISTRICT 2 OF THE PARISH OF TANGIPAHOA STATE OF LA.
Entity type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT 2 OF THE PARISH OF TANGIPAHOA STATE OF LA.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-284-2404
Mailing Address - Street 1:409 N W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-2428
Mailing Address - Country:US
Mailing Address - Phone:985-748-9485
Mailing Address - Fax:985-748-8144
Practice Address - Street 1:409 N W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2025
Practice Address - Country:US
Practice Address - Phone:985-748-7141
Practice Address - Fax:985-748-3181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL SERVICE DISTRICT 2 OF THE PARISIH OF TANGIPAHOA STATE OF LA.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-30
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
LA139-RHC2261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1943959Medicaid
LA1943959Medicaid
LA193985Medicare PIN