MEDICARE: HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LOUISIANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	184	LA

General Provider Information

NPI Number	:	1184048373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LOUISIANA

Provider Business Mailing Address
First Line	:	PO BOX 380
Second Line	:
City	:	BUNKIE
State	:	LA
Zip	:	71322-0380
Country	:	US
Telephone Number	:	318-346-3339
Fax Number	:	318-346-2737

Provider Business Practice Location Address
First Line	:	448 N WASHINGTON ST
Second Line	:
City	:	MARKSVILLE
State	:	LA
Zip	:	71351-2426
Country	:	US
Telephone Number	:	318-253-7511
Fax Number	:	318-253-7513

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	NELWYN FEHMIE
Credential	:
Telephone Number	:	318-346-3339

Provider Enumeration Date	:	02/10/2014
Last Update Date	:	05/23/2014

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