Healthcare Provider Details

I. General information

NPI: 1336714948
Provider Name (Legal Business Name): HOMER MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 W MAIN ST
HOMER LA
71040-3328
US

IV. Provider business mailing address

620 E COLLEGE ST
HOMER LA
71040-3202
US

V. Phone/Fax

Practice location:
  • Phone: 318-927-3571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNA LEE JONES
Title or Position: CQIO
Credential:
Phone: 318-927-2024