Healthcare Provider Details

I. General information

NPI: 1003925959
Provider Name (Legal Business Name): HOSPITAL SERVICE DISTRICT 2 OF THE PARISH OF TANGIPAHOA STATE OF LA.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W. WALNUT ST.
AMITE LA
70422-2025
US

IV. Provider business mailing address

301 W. WALNUT ST.
AMITE LA
70422-2025
US

V. Phone/Fax

Practice location:
  • Phone: 985-748-9485
  • Fax: 985-748-8144
Mailing address:
  • Phone: 985-748-9485
  • Fax: 985-748-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number139
License Number StateLA

VIII. Authorized Official

Name: MR. EDWARD C. DUGAR
Title or Position: CEO
Credential:
Phone: 985-748-9485