Healthcare Provider Details

I. General information

NPI: 1578891222
Provider Name (Legal Business Name): BAYNE-JONES ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 GEORGIA AVE BLDG 3507
FT POLK LA
71459
US

IV. Provider business mailing address

1585 3RD ST BLDG 285
FORT POLK LA
71459-5102
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-3118
  • Fax:
Mailing address:
  • Phone: 337-531-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN JONES
Title or Position: UBO MANAGER
Credential:
Phone: 337-653-3220