Provider Demographics
NPI:1275701518
Name:HOSPITAL SERVICE DISTRICT NO. 2
Entity Type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT NO. 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOUISSET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-507-1201
Mailing Address - Street 1:210 CHAMPAGNE BLVD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-3700
Mailing Address - Country:US
Mailing Address - Phone:337-332-2178
Mailing Address - Fax:337-332-5092
Practice Address - Street 1:210 CHAMPAGNE BLVD
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3700
Practice Address - Country:US
Practice Address - Phone:337-507-1201
Practice Address - Fax:337-332-5092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA240282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA43707OtherBLUE CROSS-PHYSICIAN
LA1799785Medicaid
LA5D111Medicare UPIN