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

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	261QR1300X	Rural Health Clinic/Center	184RHC-1	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	184RHC-1	OTHER	LA	STATE LICENSE #

General Provider Information

NPI Number	:	1811942279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LA

Provider Business Mailing Address
First Line	:	PO BOX 380
Second Line	:
City	:	BUNKIE
State	:	LA
Zip	:	71322-0380
Country	:	US
Telephone Number	:	318-346-7283
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 N LEXINGTON AVE
Second Line	:
City	:	BUNKIE
State	:	LA
Zip	:	71322-1619
Country	:	US
Telephone Number	:	318-346-7283
Fax Number	:

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	11/09/2017

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