Basic Information
| Provider Information | |||||||||
| NPI: | 1235177320 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIENVILLE MEDICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 W PINHOOK RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372331307 | ||||||||
| FaxNumber: | 3372335764 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 PINE ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ARCADIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710013113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182634700 | ||||||||
| FaxNumber: | 3182639243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 08/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | MYERS | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3372331307 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 552 | LA | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 5CY32 | 01 | LA | MEDICARE - PART B | OTHER |