Basic Information
| Provider Information | |||||||||
| NPI: | 1275010712 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLEGIANCE HOSPITAL OF MANY,LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TOLEDO BEND EXPRESS CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | MANY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714493767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182565691 | ||||||||
| FaxNumber: | 3182567540 | ||||||||
| Practice Location | |||||||||
| Address1: | 12060 TEXAS HWY | ||||||||
| Address2: | |||||||||
| City: | MANY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182565691 | ||||||||
| FaxNumber: | 3182567540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2018 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | BORDELON | ||||||||
| AuthorizedOfficialFirstName: | ROCK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3182268202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALLEGIANCE HOSPITAL OF MANY LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.