Healthcare Provider Details

I. General information

NPI: 1801147434
Provider Name (Legal Business Name): JENNINGS AMERICAN LEGION HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2012
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 ELTON RD
JENNINGS LA
70546-3614
US

IV. Provider business mailing address

1634 ELTON RD
JENNINGS LA
70546-3614
US

V. Phone/Fax

Practice location:
  • Phone: 337-616-7000
  • Fax:
Mailing address:
  • Phone: 337-616-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DANA WILLIAMS
Title or Position: CEO
Credential:
Phone: 337-616-7030