=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336207034
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMEDISYS HOSPICE, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5368 FREDERICKSBURG RD STE 210
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-6108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-541-0922
-----------------------------------------------------
Fax | 210-541-9118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3854 AMERICAN WAY SUITE A
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-292-2031
-----------------------------------------------------
Fax | 225-295-9678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP TAX
-----------------------------------------------------
Name | TRAVIS MIGLICCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-299-3803
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 013242
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------