Healthcare Provider Details

I. General information

NPI: 1124159603
Provider Name (Legal Business Name): RUSTON LOUISIANA HOSPITAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E VAUGHN AVE
RUSTON LA
71270-5950
US

IV. Provider business mailing address

401 E VAUGHN AVE
RUSTON LA
71270-5950
US

V. Phone/Fax

Practice location:
  • Phone: 615-465-7016
  • Fax:
Mailing address:
  • Phone: 615-465-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: JAMES P WRIGHT
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 615-465-7587