=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922162833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOSPITAL SERVICE DISTRICT 2 OF THE PARISH OF TANGIPAHOA STATE OF LA.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 09/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 W WALNUT ST
-----------------------------------------------------
City | AMITE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70422-2025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-748-7141
-----------------------------------------------------
Fax | 985-748-3181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 W. WALNUT ST.
-----------------------------------------------------
City | AMITE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70422-2025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 905-748-9485
-----------------------------------------------------
Fax | 985-748-8144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. EDWARD C. DUGAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 985-284-2404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number | 139
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------