Basic Information
| Provider Information | |||||||||
| NPI: | 1912973090 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNION GENERAL HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | UNION GENERAL RURAL HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 MARION HWY | ||||||||
| Address2: | |||||||||
| City: | FARMERVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712419314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183689745 | ||||||||
| FaxNumber: | 3183680072 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 MARION HWY | ||||||||
| Address2: | |||||||||
| City: | FARMERVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712419314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183689745 | ||||||||
| FaxNumber: | 3183680072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ORMOND | ||||||||
| AuthorizedOfficialFirstName: | EVALYN | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3183687090 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNION GENERAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | LA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 110484125B | 01 | LA | BLUE CROSS BLUE SHIELD | OTHER | 1442089 | 05 | LA | MEDICAID |