Healthcare Provider Details

I. General information

NPI: 1992469373
Provider Name (Legal Business Name): JENNINGS AMERICAN LEGION HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S ELMS ST
WELSH LA
70591-4211
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: 337-616-7032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JON D LAMB
Title or Position: CLINICAL ANALYST
Credential:
Phone: 337-616-7000