Healthcare Provider Details

I. General information

NPI: 1578572038
Provider Name (Legal Business Name): HOMER MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 W MAIN ST
HOMER LA
71040-3328
US

IV. Provider business mailing address

620 EAST COLLEGE ST.
HOMER LA
71040
US

V. Phone/Fax

Practice location:
  • Phone: 318-927-3571
  • Fax: 318-927-2677
Mailing address:
  • Phone: 318-927-3571
  • Fax: 318-927-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number008287
License Number StateLA

VIII. Authorized Official

Name: KEITHA COOK
Title or Position: OFFICE MANAGER
Credential:
Phone: 318-927-3571