Basic Information
Provider Information | |||||||||
NPI: | 1881678704 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UNION GENERAL HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 398 | ||||||||
Address2: | 901 JAMES AVE | ||||||||
City: | FARMERVILLE | ||||||||
State: | LA | ||||||||
PostalCode: | 712410398 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3183689751 | ||||||||
FaxNumber: | 3183687071 | ||||||||
Practice Location | |||||||||
Address1: | 901 JAMES AVE | ||||||||
Address2: |   | ||||||||
City: | FARMERVILLE | ||||||||
State: | LA | ||||||||
PostalCode: | 712412234 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3183689751 | ||||||||
FaxNumber: | 3183687071 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/05/2005 | ||||||||
LastUpdateDate: | 11/16/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ORMOND | ||||||||
AuthorizedOfficialFirstName: | EVALYN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO ADMINISTRATOR | ||||||||
AuthorizedOfficialTelephone: | 3183687066 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/16/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 146 | LA | Y |   | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
ID | Type | State | Issuer | Description | 1798754 | 05 | LA |   | MEDICAID | 19Z301 | 01 |   | SWING BED | OTHER | 1743577 | 05 | LA |   | MEDICAID |