MEDICARE: HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LOUISIANA

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	282NC0060X	Critical Access Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5D119	OTHER	LA	PTAN

General Provider Information

NPI Number	:	1316157845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LOUISIANA

Provider Business Mailing Address
First Line	:	PO BOX 380
Second Line	:
City	:	BUNKIE
State	:	LA
Zip	:	71322-0380
Country	:	US
Telephone Number	:	318-346-6681
Fax Number	:	318-346-3330

Provider Business Practice Location Address
First Line	:	427 EVERGREEN ST
Second Line	:
City	:	BUNKIE
State	:	LA
Zip	:	71322-3901
Country	:	US
Telephone Number	:	318-346-6681
Fax Number	:	318-346-3330

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	LATRICE WILLIAMS
Credential	:
Telephone Number	:	318-346-6681

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	11/09/2017

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