MEDICARE: HOSPITAL SERVICE DISTRICT # 2 OF LASALLE PARISH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	785	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	30157	OTHER	LA	BCBS

General Provider Information

NPI Number	:	1215921200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITAL SERVICE DISTRICT # 2 OF LASALLE PARISH

Provider Business Mailing Address
First Line	:	PO DRAWER 1510
Second Line	:	139 9TH ST
City	:	JENA
State	:	LA
Zip	:	71342-1510
Country	:	US
Telephone Number	:	318-992-6627
Fax Number	:	318-992-9288

Provider Business Practice Location Address
First Line	:	139 9TH ST
Second Line	:
City	:	JENA
State	:	LA
Zip	:	71342-1510
Country	:	US
Telephone Number	:	318-992-6627
Fax Number	:	318-992-9288

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. WILLIAM JOHN NUNNALLY III
Credential	:
Telephone Number	:	318-992-6627

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	05/13/2008

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