Provider Demographics
NPI:1215394572
Name:JENNINGS AMERICAN LEGION HOSPITAL INC
Entity Type:Organization
Organization Name:JENNINGS AMERICAN LEGION HOSPITAL INC
Other - Org Name:JALH PHYSICIAN CLNICS #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-616-7000
Mailing Address - Street 1:1634 ELTON RD
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3614
Mailing Address - Country:US
Mailing Address - Phone:337-616-7000
Mailing Address - Fax:
Practice Address - Street 1:1636 ELTON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3648
Practice Address - Country:US
Practice Address - Phone:337-824-8282
Practice Address - Fax:337-824-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
255643Medicare UPIN