MEDICARE: OAK TREE HOSPITAL AT BAPTIST NORTHEAST, LLC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital
2	282E00000X	Long Term Care Hospital

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2861023000	OTHER	KY	PASSPORT ADVANTAGE
3	50015894	OTHER	KY	PASSPORT
4	000000496468	OTHER	KY	ANTHEM BLUE CROSS AND BLUE SHIELD

NPI Number	:	1841240090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK TREE HOSPITAL AT BAPTIST NORTHEAST, LLC

Provider Business Mailing Address
First Line	:	1025 NEW MOODY LN
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-9154
Country	:	US
Telephone Number	:	502-222-8506
Fax Number	:	502-222-8526

Provider Business Practice Location Address
First Line	:	1025 NEW MOODY LN
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-9154
Country	:	US
Telephone Number	:	502-222-8506
Fax Number	:	502-222-8526

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JOE MURRELL
Credential	:
Telephone Number	:	502-222-8506

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	05/27/2008

1101 MEDICARE CTR. BLVD. , HOSPITALIST DEPARTMENT
MARRERO, LA
70072

Practice Phone: 504-349-1656
Practice Fax: 504-349-1933