Healthcare Provider Details

I. General information

NPI: 1053665570
Provider Name (Legal Business Name): JENNINGS AMERICAN LEGION HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 12/23/2013
Certification Date:
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: 337-616-7371
  • Fax: 337-616-7372
Mailing address:
  • Phone: 337-616-7371
  • Fax: 337-616-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHY.006628-IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN TRAHAN
Title or Position: PIC
Credential:
Phone: 337-616-7371