Healthcare Provider Details

I. General information

NPI: 1275701518
Provider Name (Legal Business Name): HOSPITAL SERVICE DISTRICT NO. 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CHAMPAGNE BLVD
BREAUX BRIDGE LA
70517-3700
US

IV. Provider business mailing address

210 CHAMPAGNE BLVD
BREAUX BRIDGE LA
70517-3700
US

V. Phone/Fax

Practice location:
  • Phone: 337-507-1201
  • Fax: 337-332-5092
Mailing address:
  • Phone: 337-332-2178
  • Fax: 337-332-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number240
License Number StateLA

VIII. Authorized Official

Name: MRS. RENA B. MOUISSET
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 337-507-1201